Microhemorrhages in diquat-induced encephalopathy identified using susceptibility-weighted imaging
1Department of Radiology, Liaocheng People's Hospital, Liaocheng, China.
Introduction:
Intracerebral bleeding that predominantly affects the pons, midbrain, cerebral peduncle, basal ganglia, and thalamus may occur in severe diquat poisoning. We employed magnetic resonance-susceptibility-weighted imaging to highlight the presence of microhemorrhages in a patient with diquat poisoning.Case summary: A 15-year-old female patient presented with kidney and liver damage after ingesting diquat. Three days later, she developed coma. She received seven sessions of hemoperfusion and was discharged with residual cognitive impairment and right limb muscle weakness after 66 days of hospitalization.Images: Cranial computed tomography on day 5 and magnetic resonance imaging on day 8 revealed swelling in the pons, midbrain, and thalamus without evidence of hemorrhage. However, susceptibility-weighted imaging on day 8 demonstrated multiple punctate low signals, suggesting the presence of microhemorrhages.
Conclusion:
Susceptibility-weighted imaging is a useful technique for detecting microhemorrhages in patients with diquat-induced encephalopathy, as microhemorrhages are often not detectable on computed tomography or conventional magnetic resonance imaging.
Insights
Severe diquat poisoning can cause intracerebral bleeding. Magnetic resonance-susceptibility-weighted imaging effectively detected microhemorrhages in a poisoning patient, which were missed by conventional imaging.
Area of Science:
- Neurology
- Toxicology
- Radiology
Background:
- Diquat poisoning can lead to severe neurological complications, including intracerebral bleeding.
- Conventional neuroimaging techniques may not detect subtle hemorrhages in diquat poisoning.
Observation:
- A 15-year-old female ingested diquat, developing kidney and liver damage, followed by coma.
- Initial cranial CT and MRI showed brain swelling but no hemorrhage.
Findings:
- Susceptibility-weighted imaging (SWI) revealed multiple punctate low signals in the brain on day 8, indicative of microhemorrhages.
- SWI is crucial for identifying microhemorrhages in diquat-induced encephalopathy.
Implications:
- SWI enhances the detection of diquat-related microhemorrhages, improving diagnostic accuracy.
- Early detection of microhemorrhages can inform treatment strategies for diquat poisoning.
