Presentation
Prolonged thoracic crush injury, asystolic arrest.
Patient Data
There is subtle bilateral globus pallidus hypoattenuation. No other abnormality.
There is now somewhat more pronounced globus pallidus hypodensity, and diffuse reduction in grey-white matter differentiation.
Widespread symmetrical cortical and deep grey matter (basal ganglia, substantia nigra and periaqueductal grey) restricted diffusion. T2 signal abnormality involves globus pallidus and caudate nucleus.
Case Discussion
This case demonstrates the imaging findings of severe global hypoxic brain injury, with extensive, symmetrical involvement of deep grey matter structures and cortical laminar necrosis. In the acute period, DWI is earliest to demonstrate the abnormality and is most sensitive in showing its extent.
The selective vulnerability of grey matter is thought to relate to its higher metabolic demand, as well as its susceptibility to glutamate toxicity.