Fig. 13.

A 38 year old female with acute pulmonary and cardiac failure and arrest causing hypoxic-ischemic encpehalopathy (HIE). 13A-C: an MRI the day after the insult shows gyriform reduced diffusion (arrows) on DWI (A), ADC map (B) and hyperintensities on FLAIR (C) within the parietal cortices bilaterally. 13D-F: Six days later, in the subacute phase, the reduced diffusion is symmetric and bilateral within the centrum semiovale of the PVWM on DWI (D) and ADC map (E), with slight hyperintensities on FLAIR (F), consistent with delayed PVWM anoxic injury from HIE, which could mimic ATL if the initial MRI was not obtained. However, ATL usually lacks the mild cortical hyperintensity as noted here (arrows, 13C).