PT  - JOURNAL ARTICLE
AU  - B K Han
AU  - R B Towbin
AU  - G De Courten-Myers
AU  - R L McLaurin
AU  - W S Ball, Jr
TI  - Reversal sign on CT: effect of anoxic/ischemic cerebral injury in children.
DP  - 1989 Nov 01
TA  - American Journal of Neuroradiology
PG  - 1191--1198
VI  - 10
IP  - 6
4099  - http://www.ajnr.org/content/10/6/1191.short
4100  - http://www.ajnr.org/content/10/6/1191.full
SO  - Am. J. Neuroradiol.1989 Nov 01; 10
AB  - A retrospective study was performed to determine the clinical and pathologic features, etiology, and outcome of children with the reversal sign. The reversal sign, a striking CT finding, probably represents a diffuse, anoxic/ischemic cerebral injury. CT features of the reversal sign are diffusely decreased density of cerebral cortical gray and white matter with a decreased or lost gray/white matter interface, or reversal of the gray/white matter densities and relatively increased density of the thalami, brainstem, and cerebellum. Twenty children with the reversal sign were retrospectively analyzed. We divided the patients into three groups: (1) acute reversal, (2) intermediate group, and (3) chronic reversal. There were nine cases of trauma (seven of child abuse); nine hypoxia/anoxia incidents (birth asphyxia, drowning, status epilepticus); one bacterial meningitis; and one degenerative encephalitis. All acute- and intermediate-group patients had respiratory problems requiring ventilator support and intensive care. In five of seven patients who died, autopsy findings were consistent with anoxic/ischemic encephalopathy. Surviving patients have profound neurologic deficits with severe developmental delay. The CT reversal sign carries a poor prognosis and indicates irreversible brain damage.