Magnetic resonance changes with spectroscopy and diffusion tensor imaging after acute cyanide poisoning in a child

We report early MR changes that occurred on day 3 and 5 weeks after the accidental cyanide ingestion in a child. As the toxicity of cyanide is based on the inactivation of cytochrome oxidase, a terminal enzyme in the cellular respiration chain, cerebral structures with the highest oxygen requirement, such as basal ganglia, cerebral cortex, and sensorimotor cortex are most commonly affected. At an early phase, the toxic changes can be visible as pronounced restricted diffusion on DWI and onset of lactate peak on MR spectroscopy when the altered signal intensity on conventional T2W and T1W sequences is still lacking. Classical T2-weighted hyperintensities develop and general reduction in fractional anisotropy (FA) is evident on diffusion tensor imaging (DTI) in the follow up study. The FA is most significantly reduced in periventricular white matter with classical T2 hyperintensities. These changes correlated well with his clinical evolution into dystonic cerebral palsy during hospitalization.