Pseudohypoxic brain swelling in a case of acute craniospinal hypotension

Pseudohypoxic brain swelling (PHBS) also known as postoperative hypotension-associated venous congestion is a serious and poorly understood postoperative complication associated with rapid postoperative deterioration. Imaging findings include acute diffuse brain swelling and flair hyperintense changes in the basal ganglia making misidentification with hypoxic ischemic encephalopathy an important pitfall. This case represents a rare example of this entity with objective volumetric confirmation for the first time as well as an incomplete lentiform fork sign. The findings question one of the current hypotheses involving brain sagging [1]. Recognition of this radiological pattern is essential for differentiation from hypoxic or metabolic encephalopathies and may guide appropriate management.