Reversal sign: a red-flag in emergency departments

Abstract

The reversal sign is an ominous finding seen on computed tomographic images of the brain as an inversion of the normal attenuation relationship between grey and white matter. This article describes the pathophysiology of the reversal sign, which indicates irreversible neural tissue damage, and includes a brief case study of a child who drowned and later developed this sign. The child died two hours after presenting to the emergency department. Emergency healthcare professionals should be aware of this sign, which is significant in terms of diagnosis, management and prognosis. Knowledge of the reversal sign will also help emergency nurses support relatives who are about to be notified about the possible long-term neurological deficits in, or death of, their loved one.

White Cerebellum Sign is a Rare Finding Representing an Irreversible Hypoxic-Ischemic Injury: A Case Report

“…This sign is important from diagnostic, therapeutic and prognostic side as treatment is primarily symptomatic and aimed to decrease intra-cranial pressure [5]. Emergency nurses and doctors should know this rare sign as it is and indicator of poor prognosis and worse outcomes [1,3,[6][7][8] and one-third of patients presenting with this sign usually die.…”

White Cerebellum Sign - An Ominous Radiological Imaging Finding: A Case Report and Review of the Literature

“…The hallmark of the white cerebellum sign is intracranial hypertension [4,7,11,12] However the exact mechanism and pathogenesis remain unclear, though several theories have been proposed [1,4,5] e) Anoxia and ischaemia elevate brain glucose. This hyperglycaemic state preferentially damages the cortex and basal ganglia [1,3].…”

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“…irreversible brain damage with subsequent development of diffuse atrophy and cystic encephalomalacia[5].The hallmark of the white cerebellum sign is intracranial hypertension[4,7,11,12] However the exact mechanism and pathogenesis remain unclear, though several theories have been proposed[1,4,5] Some of which include;a) Raised intracranial pressure causes partial venous obstruction resulting in distension of deep medullary veins [3]. b) Preferential flow to posterior circulation [2].…”