title: Reversal sign on CT: effect of anoxic/ischemic cerebral injury in children.
abstract: 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.
authors.affiliation: Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229.
authors.forename: B K
authors.initials: BK
authors.lastname: Han
authors.forename: R B
authors.initials: RB
authors.lastname: Towbin
authors.forename: G
authors.initials: G
authors.lastname: De Courten-Myers
authors.forename: R L
authors.initials: RL
authors.lastname: McLaurin
authors.forename: W S
authors.initials: WS
authors.lastname: Ball
mesh_terms: D001921:Brain / Q000473:pathology; D001929:Brain Edema / Q000150:complications / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012120:Respiration Disorders / Q000150:complications; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography