Ischemic basal ganglia injury: PET/CT images with brain MRI correlation

Abstract

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Learning Objectives: 1. To demonstrate classical findings of hypoxic-ischemic damage of the basal ganglia following a drug overdose-induced hypoxic event in an adult male. 2. To understand the prognostic implications of brain PET imaging following an ischemic brain injury.

Abstract Body: Methods: We present the clinical findings as well as the brain MRI and PET images of a 38 year-old male who has suffered an anoxic brain injury due to a overdose-related suicide attempt. Results: A 38 year-old male was admitted to our institution following an overdose on a cocktail of medications (tramadol, prazosin, gabapentin, and sertraline) and a large volume of alcohol. He was successfully resuscitated after being found cyanotic at the scene. Following several days intubated and on blood pressure support in a comatose state, he regained consciousness, but reported significant cognitive deficits that did not exist prior to the overdose. He reported slowed coordination and speech, difficulty understanding what others are saying, decreased cognition, increased anxiety and irritability, and moderately severe depressive symptoms. An MRI of the head was performed shortly after his recovery of consciousness, which demonstrated bilateral abnormal signal changes in the globus pallidus. DWI and ADC images revealed acute ischemic changes in the bilateral globus pallidus. A PET/CT of the brain was obtained two months after the event to further characterize the brain injury and to assess the patient’s prognosis for recovery of function. The PET images demonstrated decreased metabolic activity in the globus pallidus and thalamus, consistent with a persistent hypoxic injury to the basal ganglia. Conclusions: PET imaging can provide important prognostic information following a hypoxic brain injury. PET images are presented with brain MRI correlation to demonstrate a classical appearance of hypoxic-ischemic damage to the basal ganglia.