Axial contrast enhanced CT images show symmetric, thick, abnormal enhancement of the cerebral cortex. White matter attenuation is abnormally low, with loss of gray-white differentiation in the parietooccipital regions. There is no definite mass effect.
The appearance is characteristic for laminar necrosis and no other reasonable differential diagnosis exists.
Laminar necrosis is a rare manifestation of neuronal injury, with a very poor prognosis. The process results from oxygen and/or glucose depletion as is seen with anoxia, hypoglycemia, status epilepticus, or ischemic stroke. This marked cortical enhancement likely reflects a diffuse loss of the blood brain barrier and cellular disruption. Focal areas of laminar necrosis may be seen with arterial distribution infarctions, and the MR appearance of these are well described in the literature.
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