Reversal sign on CT: effect of anoxic/ischemic cerebral injury in children.
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.
Han
B K
BK
Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229.
Towbin
R B
RB
De Courten-Myers
G
G
McLaurin
R L
RL
Ball
W S
WS
D001929:Brain Edema / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D001930:Brain Injuries / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D001933:Brain Stem / Q000000981:diagnostic imaging; D002531:Cerebellum / Q000000981:diagnostic imaging; D002540:Cerebral Cortex / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013788:Thalamus / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography