0:01

This was a patient who was found down.

0:03

Unconscious. Initial CT scan was negative.

0:09

The patient remained unresponsive.

0:12

They recommended an MRI scan.

0:15

The MRI scan is performed, and here on the FLAIR

0:19

scan, what we see is abnormal symmetric bilateral

0:24

high signal intensity in the globus pallidus.

0:28

In the near region of the thalamus, as

0:31

well as in the caudate nucleus, as well

0:35

as high signal intensity bilaterally and

0:37

symmetrically in the medial temporal lobes.

0:40

Despite the fact that this patient was found

0:42

down and unconscious, you can see that there's

0:45

considerable motion artifact that's probably from

0:48

a respirator or a ventilator that's being used

0:51

to support this patient.

0:53

There also is high signal intensity in

0:55

the substantia nigra in this patient.

0:58

If you look at the cortical margin in the parietal

1:03

region, you see that it's a little bit thicker

1:05

than usual and a little bit more blurred, not

1:08

just because of the patient motion artifact.

1:11

This suggests that there is an element

1:13

of cerebral edema in this patient.

1:16

The next sequence that was looked at

1:18

was the diffusion-weighted imaging.

1:20

This is DWI.

1:22

I am gonna wind this a little bit better.

1:25

So on the DWI sequence, you see that the

1:28

caudate finding shows restricted diffusion.

1:31

There's all this cortical high signal intensity

1:35

also bilaterally that, in retrospect, maybe

1:38

we should have called on the FLAIR scan, but

1:40

was obscured by the patient motion artifact.

1:43

We noticed that the thalami, as well as the globus

1:46

pallidus region, also show high signal intensity.

1:50

And there is high signal intensity

1:52

in the medial temporal lobe.

1:54

This constellation of findings of involvement

1:57

bilaterally and symmetrically in the medial

2:00

temporal lobe, in the globus pallidus, and

2:02

for that matter, in the cerebral cortex, is

2:05

indicative of an anoxic-ischemic injury.

2:09

This is the pattern that we also see with carbon

2:12

monoxide poisoning in those patients who have a

2:15

hypoventilatory, hypoxic injury to the brain.

2:19

And this is a severe involvement.

2:22

Thalamic involvement is much more severe in

2:24

this diffuse involvement of the cerebral cortex.

2:28

All of this is going to be dead brain, and

2:30

obviously, the patient is going to be doing very

2:33

poorly and possibly in a coma for a period of time.

Case: Anoxic Brain Injury

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