Reversal sign on CT: effect of anoxic/ischemic cerebral injury in children

AJR Am J Roentgenol. 1990 Feb;154(2):361-8. doi: 10.2214/ajr.154.2.2105031.


A retrospective study was performed to determine the clinical and pathologic features, etiology, and outcome of children with the reversal sign. The reversal sign, a striking CT finding, probably represents a diffuse, anoxic/ischemic cerebral injury. CT features of the reversal sign are diffusely decreased density of cerebral cortical gray and white matter with a decreased or lost gray/white matter interface, or reversal of the gray/white matter densities and relatively increased density of the thalami, brainstem, and cerebellum. Twenty children with the reversal sign were retrospectively analyzed. We divided the patients into three groups: (1) acute reversal, (2) intermediate group, and (3) chronic reversal. There were nine cases of trauma (seven of child abuse); nine hypoxia/anoxia incidents (birth asphyxia, drowning, status epilepticus); one bacterial meningitis; and one degenerative encephalitis. All acute- and intermediate-group patients had respiratory problems requiring ventilator support and intensive care. In five of seven patients who died, autopsy findings were consistent with anoxic/ischemic encephalopathy. Surviving patients have profound neurologic deficits with severe developmental delay. The CT reversal sign carries a poor prognosis and indicates irreversible brain damage.

MeSH terms

  • Brain Edema / diagnosis
  • Brain Edema / diagnostic imaging*
  • Brain Edema / pathology
  • Brain Injuries / diagnostic imaging
  • Brain Ischemia / diagnosis
  • Brain Ischemia / diagnostic imaging*
  • Brain Ischemia / pathology
  • Brain Stem / diagnostic imaging
  • Cerebellum / diagnostic imaging
  • Cerebral Cortex / diagnostic imaging
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Hypoxia, Brain / diagnosis
  • Hypoxia, Brain / diagnostic imaging*
  • Hypoxia, Brain / pathology
  • Infant
  • Infant, Newborn
  • Male
  • Retrospective Studies
  • Thalamus / diagnostic imaging
  • Tomography, X-Ray Computed* / methods
  • Ultrasonography