Emergent CT showed increased swelling and obliteration of the basal cisterns consistent with the patient's clinical symptoms of becoming more lethargic.
Follow-up head CT on day 7 revealed a right anterior division MCA infarct with left shift, with the basal cisterns appearing to be normal.
2) In children < 18 months, the presence of a diffuse copper-beaten pattern on skull radiography, together with narrowing of the basal cisterns
and obliteration of the anterior sulci, increases the likelihood of raised intracranial pressure.
CSF may flow to cortical cisterns and sagittal sinus directly with bypassing blocked basal cisterns
Thick leptomeningeal exudates form, especially in the basal portions of the brain, obliterating the basal cisterns and leading to marked communicating hydrocephalus.
This results from spasm and thrombosis of the perforating vessels as they course through the gelatinous exudates in the basal cisterns to supply the basal ganglia.
Gadolinium-enhanced T1-weighted MR imaging demonstrated multiple diffusely enhancing lesions in the basal cisterns
, bilateral frontal, right temporal and left parietal areas (Fig.
In children younger than 18 months, the presence of a diffuse copper beaten pattern on skull radiography, together with narrowing of the basal cisterns
and obliteration of the anterior sulci, significantly decreases the likelihood of raised intracranial pressure.
A magnetic resonance imaging (MRI) scan revealed extensive gadolinium enhancement throughout the basal cisterns and meninges.
Basal cisterns show marked enhancement on CT and MRI, and noncontrast scans may show the exudate appearing as soft tissue density filling the cisterns.
5) Headache occurs secondary to meningeal irritation owing to blood entering the basal cisterns
or from dural stretching.
Instillation of the t-PA into the basal cisterns
after clipping of the ruptured aneurysm followed by irrigation artificially improves this natural process of clot clearance, and eliminates most of the RBC destruction.