cerebral pseudoatrophy secondary to leaky vessels

Posted By Roberto Bomprezzi
cerebral pseudoatrophy secondary to leaky vessels

A 52-year-old man presented with severe cytomegalovirus pneumonitis and kidney failure, and became comatose. Imaging studies documented reversible bilateral frontal hygromas, frontal lobe pseudoatrophy and fluid accumulation in the posterior cerebral regions related to the compromised blood brain barrier function. As the underlying illness improved and the systemic fluid imbalance was corrected, the cerebral volumes reversed to normal and the altered level of consciousness resolved. We highlight the impact of the systemic inflammatory state on the loss of blood brain barrier competence and the consequent, reversible global intracranial fluid redistribution. The relevance of this case stems on the fact that in the absence of inflammatory findings, pseudoatrophy could be less than easily recognized and fluid related volume changes of the cerebral white matter should be considered when interpreting a scan with a seemingly atrophic brain.

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  • Roberto Bomprezzi 2016-07-27 11:31:43

    Image findings:

    Fig 1: axial (A,B,C) and sagittal (D) CT of the head in the acute stage of the illness showing the presence of bifrontal hygromas and sulcal effacements of the parieto-occipital lobes (arrows) as an effect of gravity in the critically ill patient lying supine.

    Fig.2: MRI brain in the acute stage of illness. Fluid Attenuated Inversion Recovery (FLAIR) axial sequences (A-D)illustrating the bifrontal fluid collection with characteristics of signal consistent with blood containing hygromas. The frontal lobes show pseudoatrophy while in the parieto-occipital regions there is effacement of the cortical sulci.

    Fig3: Axial (A,B,C) and sagittal (D) images ten days later demonstrating the resolution of the frontal hygromas, and the cortical effacements and normalization of the subarachnoid spaces (arrows).


  • Roland Talanow 2016-06-28 04:27:56

    Can you please describe the image findings? Thank you.