[Hypoxic encephalopathy and cortical laminar necrosis]

Area of Science:

• Neurology
• Neuroimaging
• Pathology

Background:

• Cortical laminar necrosis involves cerebral cortex destruction, primarily the third layer, due to reduced brain energy supply.
• While autopsy studies document these lesions, neuroimaging descriptions are scarce.
• This case highlights MRI findings in hypoxic encephalopathy secondary to status epilepticus.

Observation:

• A 16-year-old female with epilepsy presented with status epilepticus and subsequent coma.
• Clinical evaluation revealed mutism, preserved blink reflex, and visual tracking, but no voluntary motor or verbal responses.
• Neurological examination showed generalized hypertonia and arm tremor.

Findings:

• Cerebral MRI demonstrated diffuse T2/FLAIR hyperintensity in the cortex and basal ganglia.
• Subcortical white matter showed T2/FLAIR hypointensity.
• T1 sequences revealed marked hypersignal outlining cortical sulci, consistent with cortical laminar necrosis.

Implications:

• Status epilepticus and prolonged hypoxia can precipitate cortical laminar necrosis.
• Neuroimaging, particularly MRI, is crucial for diagnosing these characteristic alterations.
• Understanding these radiological findings aids in managing hypoxic encephalopathy.