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Endgames Spot Diagnosis

An unusual appearance on cranial computed tomography

BMJ 2017; 357 doi: (Published 22 June 2017) Cite this as: BMJ 2017;357:j2760
  1. Rebecca Mortimer, foundation year 2 doctor, emergency department1,
  2. Christopher Bano, foundation year 2 doctor, emergency department2,
  3. David C Howlett, consultant radiologist1
  1. 1Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, UK
  2. 2King’s College Hospital NHS Trust, Denmark Hill, London, UK
  1. Correspondence to R Mortimer rmortimer1{at}

A 65 year old woman had an in-hospital cardiac arrest after hip replacement, and had a prolonged period of hypoxia during resuscitation. Spontaneous circulation was achieved and she was transferred ventilated to intensive care. She remained unconscious and underwent cranial computed tomography (CT) (fig 1). What does the cranial CT show?

Fig 1

Axial unenhanced computed tomography (CT) section at the level of the basal cisterns


There are changes of cerebral oedema with secondary apparent high density in basal cisterns and fissures—“pseudo-subarachnoid haemorrhage.”


Unenhanced CT shows generalised reduced attenuation of the brain parenchyma, with loss of grey/white matter differentiation and effacement …

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