REVERSING SIGN ON COMPUTED TOMOGRAPHY OF HYPOXIC ISCHEMIC CEREBRAL INJURY IN TWO CHILDREN.

Abstract

An anoxic ischemic cerebral injury may cause a variety of neuropathologic abnormalities, which depend on ihe age of onset, duration and intensity. Reversing sign is an uncommon radiological finding on computed tomography. It is seen mainly in cases of severe pediatric hypoxia.

The purpose of this study was to present and describe the reversing sign on computed tomography of two cases of hypoxic children.

We reviewed the clinical features, etiologies, outcome and the reversal sign on computed tomography in two interested children. They have severe developmental delay due to prolonged hypoxia in different ages at the time of on set, the one was birth asphyxia and the other was cardiopulmonary arrest after seizures. They were underwent computed tomographic examination next 1-2 months after the anoxic events to evaluate the outcome.

The reversing signs on computed tomography of our two pediatric cases were defined by reversal of the normal gray and white matter density, a relative increase density of preserved thalami, brain stem and cerebellum, some decrease volume of the white matter mantle and some ventricular dilatation. The different degrees of the decrease cerebral density, white matter volume loss and atrophic ventricular enlargement were observed. They represented various degrees of periventricular leukomalacia and cystic encephalomalacia on chronic state.

As our result and reviewed relevant literatures, we presumed that the reversing sign is an uncommon classic computed tomographic findings which are divided into acute, intermediate and chronic reversing groups. They occur following diffuse anoxic ischemic injury in any age groups. It usually represents severe brain injury, irreversible brain damage and carries a poor outcome.