Fact-sheet: Cortical laminar necrosis


Updated on 07/01/2020 at 9:29 AM

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Definition

Ischemic neuronal remodeling involving the deep layers of the cortex, with associated glial reaction and laminar deposition of lipid-laden macrophages leading to protein influx, occurring following hypoxia.

Main etiologies:

  • causes of cerebral hypoperfusion (stroke +++)
  • Low bloog glucose Hypoglycemia
  • severe anemia
  • status epilepticus
  • poisonings

Clinical features

Depends on the cause

CT

On unenhanced imaging:

  • spontaneous gyriform hyperdensity of the cortical sulci

After injection:

  • BBB permeability of the gray matter with sparing of the white matter

The appearance of lesions is generally delayed by several days when the etiology is a stroke.

MRI

  • T1: gyriform hyperintensity
  • T2 FLAIR: gyriform hyperintensity
  • T2*: no hypointensity: distinguishes cortical necrosis from hemorrhagic transformation
  • T1 post-gadolinium: gadolinium enhancement: lesions remain confined to the gray matter

The appearance of lesions is generally delayed by several days when the etiology is a stroke.

Differential diagnosis

  • Sturge-Weber-Dimitri syndrome
  • Encephalitis
  • PRES