Hemorrhagic infarct of basal ganglia in cardiac arrest. CT and MRI findings. 2 cases

Abstract

We report the CT and MRI findings in two cases of hemorrhagic infarct of the basal ganglia (BG), following out-of-hospital cardiac arrest (CA). In case 1, Brain-CT realized at day 2 showed bilateral and almost symmetric hemorrhagic infarct of the BG and infarct of the tectum of the mesencephalon. In case 2, MRI realized at day 6 showed hemorrhagic infarct of both lenticular nuclei on T2 GE images. In both cases there was no medical history and the cardiovascular and the coagulation profile were normal. In these cases, the lesions are observed earlier than reported in a few previous radiological cases. Similar lesions have been reported in pathological studies. These lesions seem occur early after CA. Reperfusion is probably responsible for the hemorrhagic transformation. The reason why some patients present either BG or brainstem infarct or both remains unclear. Bilateral and symmetric hemorrhagic infarct of the BG, especially of the Lenticular nuclei, and infarct of the dorsal pons and mesencephalic tegmentum seem to be a characteristic feature of profound and prolonged hypotension or of CA.

Methanol poisoning during the COVID‐19 pandemic in Iran: A retrospective cross‐sectional study of clinical, laboratory, and brain imaging characteristics and outcomes

“…Another previous study in Iran showed that 66.6% of patients who underwent a CT scan due to acute methanol poisoning had abnormal findings in their brain CT scans 16 . Most other studies did not have sample sizes as large as ours and were mostly case reports and case series studies 3,4,13,15 …”

“…Further studies should be established to follow up on methanol toxicity. 3,28 Although our experience with some methanol cases showed mostly normal findings on follow-up CT scans, we recommend follow-up MRI only in cases with highdegree abnormal findings on the initial CT scan.…”

“…Follow‐up MRI or magnetic resonance spectroscopy may be beneficial for evaluating patients with permanent or temporary neurological symptoms. Further studies should be established to follow up on methanol toxicity 3,28 . Although our experience with some methanol cases showed mostly normal findings on follow‐up CT scans, we recommend follow‐up MRI only in cases with high‐degree abnormal findings on the initial CT scan.…”

“…Some nonspecific abnormalities, such as sub-cortical hypodensity or intraventricular hemorrhage (IVH), have also been observed in case reports. 3,6,[12][13][14][15][16] Unfortunately, these previous studies had limited sample sizes, resulting in a lack of methanol poisoning-related imaging data.…”

“…Earlier investigations have reported the occurrence of hemorrhagic and non‐hemorrhagic necrosis in the basal ganglia, white matter, and widespread brain edema. Some nonspecific abnormalities, such as sub‐cortical hypodensity or intraventricular hemorrhage (IVH), have also been observed in case reports 3,6,12‐16 . Unfortunately, these previous studies had limited sample sizes, resulting in a lack of methanol poisoning‐related imaging data.…”