PMC4010007_01
(a) FLAIR MRI sequence demonstrates widespread abnormal signal in the subcortical white matter, internal capsule, putamen, globus pallidus, and thalamus bilaterally. (b) T1 post-gadolinium axial MRI sequence demonstrates diffuse leptomeningeal enhancement over the convexities bilaterally and foci of parenchymal enhancement within the cortex bilaterally. (c) Gradient echo (GRE/T2*) MRI sequence demonstrates hemorrhage in the deep cerebellar white matter bilaterally (mottled black signal, representing magnetic susceptibility). (d) T1 post-gadolinium coronal MRI sequence demonstrates basal leptomeningeal enhancement surrounding the brainstem. (e) Postmortem axial section through the brainstem and cerebellum demonstrates severe bilateral hemorrhage and necrosis of the cerebellar hemispheres. (f) Postmortem coronal section demonstrates widespread but patchy areas of hemorrhage and necrosis in the deep gray nuclei bilaterally and the cerebral hemispheres bilaterally.
CRIM.CRITICAL.CARE2011-562516.001.jpg
PMC4010007_01_CRIM.CRITICAL.CARE2011-562516.001.jpg
fig1
T2/FLAIR hyperintensities with swelling in the gray matter and subcortical white matter throughout the bilateral cerebral hemispheres, cerebellum, brainstem, and thalami (Figures 1(a)-1(d)). The brain showed extensive and widespread edema, necrosis, and hemorrhage (Figures 1(e)-1(f)). The cerebellar hemispheres were necrotic with associated hemorrhage (Figure 1(e)), and the basilar leptomeninges were congested.