Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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April 18, 2011
Global Anoxic/Hypotensive Cerebral Injury
- This can result from reduced perfusion or oxygenation to the brain.
- Causes include prolonged hypotension, cardiac arrest, and profound hypoxia.
- Major vessel stenosis and poor cardiac output are predisposing factors.
- Most patients present with altered mental status, focal neurologic deficits and coma.
- Key Diagnostic Features: MR is the imaging study of choice. Diffusion restriction will be seen involving the deep gray matter structures, especially the corpus striatum. In addition, diffusion restriction can be seen involving the cortical gray matter, either in a watershed distribution or more diffusely, to result in a pseudo-laminar necrosis appearance. Deep white matter watershed infarcts can also be seen.
- DDx: Creutzfeldt-Jacob disease, Hyperammonemic encephalopathy
- Treatment: Treating the underlying condition—improving perfusion, oxygenation is important. Correction of hypotension and revascularization of major vessel stenosis are important considerations.
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