Male, 11 years old, with altered mental status, status post cardiac arrest. Evaluate for HIE. History of spinal muscular atrophy type 1. Mild, bilaterally symmetric restricted diffusion is evident within the precentral cortex, bodies of the caudate nuclei, the posterior lateral putamina and the ventromedial thalami. Mild gyriform restricted diffusion is also suspected within the occipital cortex and questionably along the left hippocampal formation.The background brain demonstrates marked bilateral cerebral white matter loss with widening of the ventricles and sulci. The degree of white matter loss seems to have progressed when compared to a prior head CT from 2005. Small areas of cavitation are also evident along the right frontal horn.The corpus callosum is thinned. Although the quantity of white matter is deficient, the pattern of myelination is essentially mature. The brainstem may be somewhat slender but is otherwise normally formed. The cerebellar vermis and cerebellar hemispheres are unremarkable.No evidence of significant intracranial hemorrhage is seen. Prominence of the CSF spaces anterior to the temporal lobes could represent volume loss or, less likely, the presence of arachnoid cysts.Layering fluid is evident within the nasal cavity and nasopharynx.
1.Findings are seen compatible with hypoxic ischemic injury involving the peri-Rolandic cortex, basal ganglia and thalami, the occipital cortex, and possibly the left hippocampus.2.These findings exist on a background of extensive white matter volume loss which seems to have progressed from a 2005 examination.