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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January 7, 2013
Hypoxic Ischemic Encephalopathy (HIE) and Cortical Laminar Necrosis
- HIE results from a global insult, either from hypoperfusion or hypoxia in the setting of sufficient perfusion. Most common causes: cardiac arrest and respiratory failure
- CT and MR images may be deceptive without proper windowing.
- Key Diagnostic Features:
- Initial CT is often interpreted as normal.
- Mild gyral bright signal, swelling, and pronounced gray-white differentiation may be seen on T2WI and FLAIR.
- Marked gray-white matter differentiation on properly windowed DWI (250/150).
- Diffuse, cortical restricted diffusion (ADC) → cortical laminar necrosis.
- Associated with extremely poor outcome: brain death or persistent vegetative state.
- DDx: CJD; hypoglycemia; post-ictal state; hyperammonemic encephalopathy