Delayed nonhemorrhagic encephalopathy following mild head trauma

Case report

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✓ Delayed nonhemorrhagic encephalopathy following mild head trauma is a rare condition with an unknown etiology. The few cases reported in the literature are in young adults, all of them in the era before computerized tomography (CT) became available, and all had a devastating clinical course with multifocal ischemia or necrotic lesions found at autopsy. A case is presented of a young man with this syndrome who survived the acute encephalopathic phase with severe residual neurological deficits. Repeat CT scans during and following the acute phase as well as magnetic resonance imaging showed diffuse multifocal lesions compatible with ischemic changes and demyelination in the “watershed” areas of the brain.

Article Information

Address reprint requests to: Zvi Ram, M.D., Department of Neurosurgery, The Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel.

© AANS, except where prohibited by US copyright law.

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    Upper Pair: Unenhanced computerized tomography (CT) scans of the brain on admission with a normal gray/white matter differentiation. No changes were observed after the administration of contrast material (not included). Lower Pair: Unenhanced repeat CT scans 3 days after admission. Large hypodense regions in the watershed areas of both hemispheres are evident, with edema and a slight symmetrical ventricular compression. Again, no changes were noted after intravenous injection of contrast material (not included).

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    Upper Pair: Magnetic resonance (MR) images of the brain (spin-echo, T1- and T2-weighted images) obtained 21 days after admission. Scattered small hyperintense lesions in the white matter or both hemispheres are seen. A symmetrical enlargement of both ventricles is also present. Lower Pair: Computerized tomography scans obtained on the same day as the MR images. The hypodense white matter areas are barely visible. A symmetrical enlargement of both ventricles with deep sulci is evident secondary to moderate brain atrophy.

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