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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 and irreversible neurological deficits.
Area of Science:
- Neuroradiology
- Pediatric Neurology
- Neuroimaging
Background:
- The reversal sign is a CT finding in children.
- It is associated with diffuse anoxic/ischemic cerebral injury.
- CT features include altered gray/white matter densities and increased density in specific brain regions.
Purpose of the Study:
- To determine clinical and pathologic features of the reversal sign in children.
- To investigate the etiology and outcome of children with this sign.
- To establish the prognostic value of the reversal sign.
Main Methods:
- Retrospective analysis of 20 children with the reversal sign.
- Categorization into acute, intermediate, and chronic groups.
- Review of clinical data, CT findings, and autopsy reports.
Main Results:
- Etiologies included trauma (child abuse), hypoxia/anoxia (birth asphyxia, drowning), meningitis, and encephalitis.
- Patients required ventilatory support and intensive care.
- Autopsy findings confirmed anoxic/ischemic encephalopathy in deceased patients.
- Survivors exhibited profound neurologic deficits and developmental delay.
Conclusions:
- The CT reversal sign is a marker of severe, irreversible brain damage in children.
- It is associated with poor prognosis and significant long-term disability.
- Early identification is crucial 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.
