Can postmortem computed tomography detect antemortem hypoxic–ischemic encephalopathy?

Shirota, Go; Ishida, Masanori; Shintani, Yoshizumi; Abé, Hiroyuki; Ikemura, Masako; Fukayama, Masashi; Gonoi, Wataru

doi:10.1007/s12024-016-9787-8

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…The antemortem CT findings of loss of gray and white matter differentiation and symmetrical, low-density cerebral edema have typically been reported for hypoxic–ischemic encephalopathy on antemortem CT [14] , consistent with the present case. The postmortem CT findings of sulcal effacement of the cerebral hemisphere and the loss of contrast at the basal ganglia are characteristic findings of hypoxic–ischemic encephalopathy on postmortem CT [7] , [8] , [9] , [10] , [11] , which were also consistent with the present case. Furthermore, in the present case, we observed delayed enhancement of deep gray matter, such as the caudate nucleus and putamina, on postmortem CT. To the best of our knowledge, this is the first report on these postmortem CT findings.…”

Section: Discussionsupporting

confidence: 89%

“…According to previous studies examining brain postmortem CT, the loss of gray and white matter differentiation, diffuse brain swelling, and pseudo-subarachnoid hemorrhages were often observed in nonpathological brains and hypoxic–ischemic encephalopathy [7] , [8] , [9] , [10] , [11] . Another study examining voxel-based analyses reported a rapid decrease in cortical gray matter density combined with a delayed increase in white matter density [12] .…”

Section: Introductionmentioning

confidence: 95%

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Delayed cerebral enhancement on post-mortem computed tomography due to residual contrast medium administered shortly before death

Okimoto

Ishida

Abé

et al. 2021

Radiology Case Reports

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Postmortem computed tomography (CT) is currently a well-known procedure and helps in postmortem investigations. In this case report, we report a unique postmortem CT finding: delayed cerebral enhancement associated with the antemortem infusion of contrast medium. A 72-year-old female lost consciousness at a restaurant and was taken to a hospital in an ambulance. Despite resuscitation efforts, she died of hypoxic–ischemic encephalopathy caused by cardiac arrest. About 6 h before her death, she underwent enhanced antemortem CT of the head. No abnormal enhancement was observed in the cerebral parenchyma. Then, 11 h after her death, she underwent unenhanced postmortem CT, which showed bilateral hyperdense caudate nucleus and putamina, due to residual iodinated contrast medium, in addition to other characteristic findings of hypoxic–ischemic encephalopathy. The mechanism underlying this phenomenon could be the destruction of the blood–brain barrier, and/or selective vulnerability, due to hypoxic–ischemic changes in the gray matter. Enhancement of basal ganglia on postmortem CT due to antemortem infusion of iodinated contrast medium might suggest hypoxic–ischemic encephalopathy, which should be noted in postmortem CT interpretations.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 95%

Delayed cerebral enhancement on post-mortem computed tomography due to residual contrast medium administered shortly before death

Okimoto

Ishida

Abé

et al. 2021

Radiology Case Reports

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“…In the very early postmortem period, loss of gray–white matter differentiation because of cellular edema is rarely accompanied by severe brain swelling [ 32 ]. Changes in basal ganglia density may help distinguish these from postmortem changes [ 66 ]. In addition, a gross neck mass that narrows the airway can be determined by postmortem CT [ 67 ].…”

Section: Diagnosable or Non-diagnosable Pathology On Non-contrast-enh...mentioning

confidence: 99%

Essence of postmortem computed tomography for in-hospital deaths: what clinical radiologists should know

et al. 2023

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Postmortem computed tomography (CT) is an essential tool for investigating the causes of death. Postmortem CT has characteristic imaging findings and should not be interpreted in the same manner as clinical antemortem images. In analyzing the cause of death in in-hospital death cases using postmortem images, it is crucial to understand early postmortem and post-resuscitation changes. In addition, it is essential to understand the limitations of diagnosing the cause of death or significant pathology relating to death on non-contrast-enhanced postmortem CT. In Japan, there has also been social demand to establish a system for postmortem imaging at the time of death. To facilitate such a system, clinical radiologists should be prepared to interpret postmortem images and assess the cause of death. This review article provides comprehensive information regarding unenhanced postmortem CT for in-hospital death cases in daily clinical practice in Japan.

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“…The results showed that there was a tendency to increase brain weight in patients with TA, with severe cerebral vascular congestion, perivascular hemorrhage and occasional β‐APP deposition, which was consistent with early axonal destruction (Al‐Sarraj S, et al, 2017). Some studies have shown that if a patient has hypoxic‐ischemic encephalopathy (HIE) before death, the disappearance of cerebral hemispheric sulcus and the loss of contrast at the basal ganglia level can be found by computer tomography (PMCT) after brain death (Shirota G, et al, 2016). From the above results, it can be found that different parts of the brain have different morphological and pathological changes after cerebral ischemia.…”

Section: Morphology and Pathology Of Cerebral Ischemiamentioning

confidence: 99%

Research progress of IGF‐1 and cerebral ischemia

Zhou

et al. 2021

Ibrain

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Cerebral ischemic disease is a group of diseases that cause insufficient blood supply to the cerebrum, cerebellum or brain stem for different reasons, resulting in corresponding nervous system symptoms. Cardiovascular disease is the leading cause of death in the world. Among them, the death caused by cerebral ischemia accounts for the vast majority, and it is one of the fatal diseases in the middle‐aged and elderly at present. Epidemiologic studies have projected increasing mortality due to cardiovascular disease worldwide (about 23.3 million people by 2030) because of the aging population. However, related studies have shown that insulin‐like growth factor I (IGF‐1) is a multifunctional cell proliferation regulator. It plays an important role in cerebral ischemia. It is effective in promoting cell differentiation, proliferation and individual development. Studies have shown that IGF‐1 signaling pathway is a key pathway controlling cell growth and survival. There may be five mechanisms in cerebral ischemia: prevention of intracellular calcium overload, inhibition of the upregulation of nNOS, IGF‐1upregulations activating HIF‐1α, regulation of Bcl‐2 to resist apoptosis, and enhancement of vascular endothelial function. Three critical nodes in the IGF‐1 signaling pathway have been described in cardiomyocytes: protein kinase Akt/mammalian target of rapamycin (mTOR), Ras/Raf/extracellular signal‐regulated kinase (ERK), and phospholipase C (PLC)/inositol 1,4,5‐triphosphate (InsP3)/Ca2+. IGF‐1 plays an important role in cerebral ischemia and myocardial ischemia, mainly by activating downstream of IGF‐1, controlling cell death and differentiation or transcription work, improving the function of heart muscle cells, reducing the myocardial cell apoptosis induced by myocardial infarction, regulating endogenous protection and restoration of cerebral ischemia injury, thus protecting cerebral and myocardial injury. Related studies have shown that bcl‐2 exerts great influence on both cerebral ischemia and myocardial ischemia. Therefore, the relevant pathways and targets of cerebral ischemia and myocardial ischemia and the role of IGF‐1 in protecting the heart are reviewed in this paper.

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Can postmortem computed tomography detect antemortem hypoxic–ischemic encephalopathy?

Cited by 5 publications

References 21 publications

Delayed cerebral enhancement on post-mortem computed tomography due to residual contrast medium administered shortly before death

Delayed cerebral enhancement on post-mortem computed tomography due to residual contrast medium administered shortly before death

Essence of postmortem computed tomography for in-hospital deaths: what clinical radiologists should know

Research progress of IGF‐1 and cerebral ischemia

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