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Value of MR Imaging of the Brain in Children with Hypoxic Coma

Catherine Christophea, Christine Fonteyneb, France Ziereisena, Florence Christiaensb, Paul Deltenrec, Viviane De Maertelaerd and Bernard Danb

a Department of Imaging, Hôpital Universitaire des Enfants Reine Fabiola
b Department of Pediatrics, Hôpital Universitaire des Enfants Reine Fabiola
c Department of Neurology, Centre Hospitalier Universitaire Brugmann
d IRIBHN, Statistical Unit, Free University of Brussels, Belgium



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  		FIG 1. Images of a patient who experienced cardiorespiratory arrest of unknown cause at age 2.5 months. The infant died 18 days after the event.

A, Axial spin-echo T2-weighted image (3700/150), obtained 28 hours after the event (class A), shows mild cortical and white matter hyperintensity, consistent with edema, and mild focal cortical T2 hypointensity (long arrows). Watershed areas score, 1/4. Fuzzy hyperintense areas (short arrow) are also seen in the posterior lentiform nuclei. Basal ganglia score, 1/4; total MR imaging score, 2/8.

B, Axial spin-echo T2-weighted image (3700/150), obtained 16 days after the event (class C). Diffuse T2 hyperintensity and loss of gray-white matter differentiation are consistent with severe cortical and white matter involvements. Focal cortical T2 hypointensity was also seen. Watershed areas score, 4/4. Prominent involvements in all the basal ganglia are present in caudate nuclei, lentiform nuclei, and thalami as important signal intensity modifications (abnormal hyperintense and hypointense areas). Basal ganglia score, 4/4. There is, moreover, an involvement in the posterior limb of the internal capsule as T1 and T2 prolongation (arrow). Total MR imaging score, 8/8.

C, Axial inversion-recovery T1-weighted image (1600/600/35), obtained 16 days after the event (class C). T1 hyperintensity was also seen. Watershed areas score, 4/4. Prominent involvements in all the basal ganglia are present in caudate nuclei, lentiform nuclei, and thalami as important signal intensity modifications (abnormal hyperintense and hypointense areas). Basal ganglia score, 4/4. There is, moreover, an involvement in the posterior limb of the internal capsule as T1 and T2 prolongation (arrow). Total MR imaging score, 8/8.



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  		FIG 2. Images of a patient who experienced near-drowning at age 21-months. The patient died 16 days after the event.

A, Coronal T2-weighted FLAIR image (6000/2000/150), obtained 7 days after the event (class B), shows supratentorial moderate cortical tumefaction and hyperintensity (compared with the cerebellar cortex). Watershed areas score, 4/4.

B, Coronal T2-weighted FLAIR image (6000/2000/150), obtained 7 days after the event (class B). Basal ganglia involvement can be seen with fuzzy margins and T2 hyperintensity (lentiform nuclei, caudate nuclei, and subthalamic nuclei hyperintensity). Basal ganglia score, 4/4; total MR imaging score, 8/8.

C, Coronal T2-weighted FLAIR image (6000/2000/150), obtained 14 days after the event (class C). The cortex is no longer swollen but is still diffusely hyperintense. Watershed areas score, 4/4. More prominent basal ganglia hyperintensity can be seen. Basal ganglia score, 4/4; total MR imaging score, 8/8.



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  		FIG 3. Images (MR imaging class D) of a patient who experienced hypovolemic shock and cardiorespiratory arrest due to intestinal necrosis secondary to volvulus at age 4.5 years. The outcome was good (neurologic evolution = 0).

A, Axial proton density–weighted image, obtained 18 days after the event, shows stripe of hyperintensity in the parasagittal cortex (arrows).

B, Unenhanced axial T1-weighted image (500/20), obtained 18 days after the event, shows parasagittal cortical swelling (arrows).

C, Contrast-enhanced axial T1-weighted image (500/20), obtained 18 days after the event, shows mild cortical enhancement (arrow).

D, Coronal T2-weighted FLAIR image (6000/2000/150) shows areas of hyperintense signal in the cortical parasagittal anterior region. Hyperintense signal was also seen in the posterior region (not shown) and basal ganglia (caudate and lentiform nuclei). Watershed areas score, 3/4; basal ganglia score, 3/4; total MR imaging score, 6/8.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X