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Published on: December 28, 2014
Reversal sign on CT: effect of anoxic/ischemic cerebral injury in children
B K Han1, R B Towbin, G De Courten-Myers
1Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229.
Insights
The reversal sign on CT scans in children indicates severe brain damage, often from trauma or lack of oxygen. This finding suggests a poor prognosis with irreversible neurological deficits.
Area of Science:
- Neuroradiology
- Pediatric Neurology
- Neuroimaging
Background:
- The reversal sign is a specific computed tomography (CT) finding in children.
- It is associated with diffuse anoxic/ischemic cerebral injury.
- Understanding its clinical and pathological features is crucial for prognosis.
Purpose of the Study:
- To determine the clinical and pathological features of the reversal sign in children.
- To investigate the etiology and outcomes associated with this CT finding.
- To correlate CT findings with patient outcomes and autopsy results.
Main Methods:
- Retrospective analysis of 20 pediatric patients with the reversal sign on CT scans.
- Categorization of patients into acute, intermediate, and chronic reversal groups.
- Review of clinical data, etiology, and autopsy findings where available.
Main Results:
- Etiologies included trauma (child abuse), hypoxia/anoxia (birth asphyxia, drowning), bacterial meningitis, and encephalitis.
- Patients often required mechanical ventilation and intensive care.
- Autopsy findings in deceased patients confirmed anoxic/ischemic encephalopathy.
- Surviving patients exhibited profound neurological deficits and developmental delay.
Conclusions:
- The reversal sign on CT scans in children is a marker of severe, irreversible brain damage.
- It is associated with a poor prognosis, often resulting in significant neurological impairment or death.
- Prompt recognition of this sign is critical for patient management and counseling.
Abstract:
A retrospective study was performed to determine the clinical and pathologic features, etiology, and outcome of children with the reversal sign. The reversal sign, a striking CT finding, probably represents a diffuse, anoxic/ischemic cerebral injury. CT features of the reversal sign are diffusely decreased density of cerebral cortical gray and white matter with a decreased or lost gray/white matter interface, or reversal of the gray/white matter densities and relatively increased density of the thalami, brainstem, and cerebellum. Twenty children with the reversal sign were retrospectively analyzed. We divided the patients into three groups: (1) acute reversal, (2) intermediate group, and (3) chronic reversal. There were nine cases of trauma (seven of child abuse); nine hypoxia/anoxia incidents (birth asphyxia, drowning, status epilepticus); one bacterial meningitis; and one degenerative encephalitis. All acute- and intermediate-group patients had respiratory problems requiring ventilator support and intensive care. In five of seven patients who died, autopsy findings were consistent with anoxic/ischemic encephalopathy. Surviving patients have profound neurologic deficits with severe developmental delay. The CT reversal sign carries a poor prognosis and indicates irreversible brain damage.
