Presentation
Post cardiac arrest infant with prolonged downtime at the scene. Maintained on inotropic support and mechanical ventilation.
Patient Data
Age: 12 month
Gender: Male
Axial non-contrast
- significant generalized low attenuation of the entire brain parenchyma and to less extent cerebellum (density of cerebellum is greater than cerebral hemispheres => reversal sign)
- evidence of diffuse cerebral edema with effacement of the grey-white matter borders and marked effacement of the brain sulci as well as major cisterns
- attenuated (non visualized) ventricular system with no midline shift
- associated hyper-density is noted within the cisterns giving the appearance of pseudo-subarachnoid hemorrhage due to effacement of the subarachnoid space surrounding blood vessels.
- grey-white matter interface has been lost as well
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Axial C+ arterial phase
CT angiography demonstrates faint/poor opacification of the cortical cerebral arteries distal to the middle cerebral arteries and internal cerebral veins, however, fair opacification of carotid and vertebral arteries.
Case Discussion
A typical case of pseudo-subarachnoid hemorrhage in an infant with post cardiac arrest with resultant hyoxic/anoxic cerebral insult. Consequent diffuse brain edema and swelling where there is global decrease in parenchymal attenuation.
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