Microhemorrhages in diquat-induced encephalopathy identified using susceptibility-weighted imaging

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.

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.