Cerebral Edema with Brain Death

Findings:

Axial noncontrast CT images demonstrate abnormal effacement of the suprasellar cistern and third ventricle, associated with reduced or absent gray white differentiation over the temporal lobes. There is mild oval deformity of the brainstem. The sulci are effaced. Asymmetric hyperdensity of the falx and tentorium is accentuated against low-density brain parenchyma. Subsequent nuclear medicine SPECT study demonstrates absence of radiotracer uptake within the intracranial compartment.

Discussion/Differential Diagnosis:

Symmetric abnormalities may be difficult to detect for the novice, but the third ventricle should be visible in all patients of any age, and if not visible, significant increased intracranial pressure should be suspected. The accentuated density of the falx and tentorium as well as sometimes the vessels is known as the "pseudosubarachnoid hemorrhage" sign.

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