Older age, lower BMI and higher post-TIPS portosystemic gradients were associated with higher hazards of shunt thrombosis after TIPS creation using stent grafts. Higher rates of shunt thrombosis were seen in patients for whom TIPS creation was clinically unsuccessful. The association between TIPS thrombosis and higher post-TIPS portosystemic gradients may indicate impaired flow through the shunt, a finding which may be technical or anatomic in nature and should be assessed before procedure completion.
Anoxic brain injury on magnetic resonance imaging classically demonstrates symmetric diffusion restriction involving the highly metabolic structures including the basal ganglia and cortex and global hyperperfusion on arterial spin labeling perfusion. The pattern of injury is classically diffuse and bilateral owing to global oxygen deprivation from systemic causes, most commonly cardiac arrest. In cases of suspected nonaccidental trauma presenting with a unilateral anoxic injury pattern, strangulation with temporary occlusion of a unilateral carotid artery should be considered. We present 2 cases of unilateral anoxic brain injury due to strangulation identified on magnetic resonance imaging and arterial spin labeling perfusion.
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