【病例】脑缺血缺氧性损伤1例CT影像表现

History: A 4-year-old boy was found in a pool. He had been there for an unknown period of time. He had a Glasgow Coma Scale (GCS) score of 5 upon arrival at the hospital.

病史:4岁男孩在一水塘里被发现,溺水时间不确定。送到医院时格拉斯哥昏迷量表评分为5分。

【病例】脑缺血缺氧性损伤1例CT影像表现

【病例】脑缺血缺氧性损伤1例CT影像表现

【病例】脑缺血缺氧性损伤1例CT影像表现

【病例】脑缺血缺氧性损伤1例CT影像表现

Findings

Noncontrast CT shows diffuse effacement of the sulci with “slit-like” ventricles and loss of gray-white differentiation. The presence of a “white cerebellum sign” and of early tonsillar herniation also is seen.

Differential diagnosis

  • Hypoxic-ischemic injury
  • Toxic-metabolic disorder
  • Seizures
  • Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS)

Diagnosis: Hypoxic-ischemic injury due to near drowning

影像表现:CT平扫可见脑沟广泛变浅、消失,脑室呈裂隙样变窄,灰白质分界消失;另可见“白小脑征”及早期扁桃体疝。

鉴别诊断:

  • 缺氧缺血性损伤
  • 中毒性代谢障碍
  • 癫痫
  • 线粒体脑肌病伴高乳酸血症和卒中样发作

诊断: 

缺氧缺血性损伤(近乎溺死所致)


Discussion

Hypoxic-ischemic injury

In children, near drowning is a relatively common cause of hypoxic-ischemic injury. Othercauses include cardiac arrest, cerebrovascular disease, and asphyxiation.

No matter what the cause, findings include symmetric effacement of the ventricles and other CSF-containing spaces, as well as a loss of gray-white differentiation. The basal ganglia also may show decreased attenuation on CT. If MRI is performed (often not necessary), DWI is the most sensitive sequence.

When hypoxic-ischemic injury is suspected, the finding of a hyperattenuating cerebellum compared with hypoattenuating cerebral hemispheres portends a poor prognosis. In general, the diagnostic checklist should include involvement of deep gray nuclei and also excluding the presence of herniation.

在儿童,近乎溺死是缺氧缺血性损伤相对常见的病因,其它原因包括心脏骤停、脑血管病、窒息。

无论什么病因,影像表现都为对称性的脑室及其它含脑脊液空间消失、变浅,灰白质分界不清。CT上基底节也表现为密度减低,如果行MRI扫描(非必要的),DWI是显示病变最敏感的序列。

当怀疑缺氧缺血性损伤时,相对密度减低的大脑半球,小脑密度增高,提示预后较差。通常,诊断时需注意有无灰质核团受累及脑疝形成。

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