Abstract
In the diagnosis of hypoxic encephalopathy, feasibilities of magnetic resonance images (MRI), particularly diffusion-weighted images (DWI), have been well documented. In this report, we describe a case in which MR perfusion image with pulsed arterial spin labeling (ASL) was useful to evaluate the pathology of hypoxic encephalopathy after cardiopulmonary resuscitation. A 72-year-old female with diabetes and fractures of humerus and olecranon was admitted to our hospital (Day 0). She suddenly developed cardiopulmonary arrest in the next morning and cardiopulmonary resuscitation (CPR) was promptly performed (Day 1). She presented with a persistent consciousness disorder, although her vital signs were maintained stable after CPR. On Day 11, the first MRI evaluation was performed and ASL showed an apparent increase in blood flow in the bilateral striatum, while DWI showed only a slight hyperintensity in the same area. In the T1-weighted images of Day 33 and Day 61, hyperintensities appeared stepwise in the striatum on both sides, while the blood flow in the same area decreased in ASL. Fujioka et al. previously reported the pathophysiology of T1 hyperintensity in the striatum after ipsilateral hemispherical transient or mild ischemia in animal models and clinical cases. The pathology of our case was considered to be consistent with their observations and occurred in both sides after hypoxia due to cardiac arrest. Addition of ASL to the conventional MRI method may improve the accuracy of image evaluation for hypoxic encephalopathy.
