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Diffuse anoxic brain injury post cardiac arrest

Case contributed by Ali Alsmair
Diagnosis probable

Presentation

History of post cesarean section cardiac arrest due to pulmonary embolism. The patient was successfully resuscitated, and became well for a one day, then she became comatose.

Patient Data

Age: 30 years
Gender: Female

There is extensive diffusion restriction of the bilateral cerebral white matter, extending to the centrum semiovale and also involving the bilateral globi pallidi and posterior limbs of internal capsules, with sparing of the subcortical U fibers and cerebellar hemispheres. This area of diffusion restriction corresponds to isointense signal on T1 and faint high signal intensity on T2/FLAIR.

Features are consistent with global hypoxic-ischemic injury.

No intracranial hemorrhage.

Minimal retained fluid in the bilateral mastoid air cells.

Case Discussion

The MR findings and clinical course are somewhat unusual. 

The initial period of normality followed by neurological deficit and white matter abnormalities suggested delayed posthypoxic leukoencephalopathy however the very short interval between initial insult and severity of neurological dysfunction are atypical. 

The alternative diagnosis is that of diffuse anoxic brain injury which can, albeit less frequently than grey matter, affect the white matter diffusely. As such this diagnosis is favored. 

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