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Imaging of head trauma
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
On CT, global hypoxic-ischaemic brain injury results in diffuse reduction in density of the brain with swelling (Figure 3.35). As the basal ganglia is metabolically most active, the initial findings may be very subtle with reduction in density of the deep grey matter with loss of definition of the caudate nucleus and lentiform nucleus, both of which are normally of higher density relative to the internal capsule. With increasing severity, the whole brain may become generally hypodense with loss of all grey-white matter differentiation, sulcal effacement and obliteration of the basal cisternal CSF spaces, and with collapsed ventricles. At the later stage, the cerebellum appears dense relative to the cerebral hemispheres, the so-called white cerebellum sign or the reversal sign, which indicates irreversible brain damage and has a very poor prognosis. Pseudo-subarachnoid haemorrhage sign also indicates severe hypoxia and a tight brain where the middle cerebral arteries appear hyperdense in the Sylvian fissures (Figure 3.36).
Normal Brain Development and Congenital Malformations
Published in Swati Goyal, Neuroradiology, 2020
CT: Less-sensitive modality for evaluating HIE because of inadequate parenchymal contrast resolution due to the high water content of the brain parenchyma and the high protein content of the CSF in the neonatal brain, apart from the inherent drawback of radiation exposureReversal sign – reversal in normal CT attenuation of gray matter and white matterWhite cerebellum sign – reduced density of cerebral cortical gray and white matter, loss of the gray–white matter interface, and the increased density of thalami, brainstem, and cerebellum suggest irreversible brain damage
Paediatrics
Published in Vincent Helyar, Aidan Shaw, The Final FRCR, 2017
Bilateral low-density basal ganglia, cerebral oedema.Occasionally, there is reversal of the normal pattern of grey and white matter attenuation (white matter appears more dense than the grey matter)—the ‘reversal sign’.Diffuse cortical oedema with sparing of the cerebellum causes the ‘white cerebellum sign’.
Abusive head trauma in India: imaging raises the curtain
Published in International Journal of Injury Control and Safety Promotion, 2022
Hima Pendharkar, Shumyla Jabeen, Nupur Pruthi, K. V. L. N Narasinga Rao, Dhaval Shukla, Nitish Kamble, Kavita V. Jangam, John Vijay Sagar Kommu, Thennarasu Kandavel, Senthil Amudhan
Imaging revealed SDH in 42/48 (87.5%), and SDE in 5/48 (10.41%) cases; 1/48 (2.08%) case had only hypoxia. Convexity SDH was noted in 36/42 (85.7%) cases, it was bilateral in 11/36 (30.5%) cases and unilateral in 25/36 (69.4%) cases - where it was on the right in 14/25 (56%) and on the left in 11/25 (44%) cases. SDH was noted in the posterior interhemispheric fissure (PIHF) in 35/42 (83.3%) cases, tentorial in 24/42 (57.1%) cases, in the posterior fossa in 16/42 (38.1%) cases and in the anterior interhemispheric fissure (AIHF) in 11/42 (26.2%) cases. Hypoxia underlying SDH was seen in 13/42 (31%) cases, hypoxia underlying SDH and contralateral to SDH was noted in 9/42 (21.4%) cases of which 6/9 (67%) cases showed white cerebellum sign; isolated infarcts were noted in 7/48 (14.5%) cases. SAH was noted in 14/48 (29.16%) cases, parenchymal hematoma in 9/48 (18.75%) cases and IVH in 2/48 (4.2%) cases. A skeletal survey and chest x-ray were available for 7/48 (14.5%) and 29/48 (60%) cases respectively. Skull fractures were noted in 9/48 (18.75%) cases and sutural diastasis in 3/48 (6.25%) cases. One of the forty eight cases had C2 fracture (2.1%), and 1/48 (2.1%) had C4–C5 dislocation, one child had an epidural hematoma (2.1%). Among other injuries, rib fractures were noted in 2/48 (4.2%) patients, 1/48 (2.1%) cases had a tibial fracture, and 1/48 (2.1%) case had a radial fracture. The imaging features are summarized in Table 2. Findings of fundus evaluation were available in 10/48 (20.83%) of our cases and have been summarized in Table 3.