Hypoxic Brain Injury Following Drug Packet Rupture

This young adult male patient collapsed on an international flight.
A cerebral CT was performed for ongoing reduced level of consciousness.
An abdominal CT was performed.
The radiological findings are:
Bilateral globus pallidus hypodensity consistent with hypoxic brain injury.
Rounded heterogeneous structures in stomach and bowel (drug packets).
The “knot sign” - an eccentric low density nodule on the drug packet, representing the knot in the condom.
These findings together suggest drug packet rupture followed by collapse, hypoxia and subsequent brain injury.
Credit: Dr Laughlin Dawes
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