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Patterns of neonatal hypoxic-ischaemic brain injury.

de Vries LS, Groenendaal F - Neuroradiology (2010)

Bottom Line: Enormous progress has been made in assessing the neonatal brain, using magnetic resonance imaging (MRI).In this review, we will describe the use of MRI and proton magnetic resonance spectroscopy in detecting different patterns of brain injury in (full-term) human neonates following hypoxic-ischaemic brain injury and indicate the relevance of these findings in predicting neurodevelopmental outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands. l.s.devries@umcutrecht.nl

ABSTRACT
Enormous progress has been made in assessing the neonatal brain, using magnetic resonance imaging (MRI). In this review, we will describe the use of MRI and proton magnetic resonance spectroscopy in detecting different patterns of brain injury in (full-term) human neonates following hypoxic-ischaemic brain injury and indicate the relevance of these findings in predicting neurodevelopmental outcome.

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Related in: MedlinePlus

Full-term infant with watershed pattern of injury. Born with severe anaemia (Hb 2.2 mmol/l) following fetomaternal transfusion and a short period of hypoglycaemia (<1.1 mmol/l). Loss of cortical ribbon is noted on the T2SE (TR 6284/TE 120; a), and the corpus callosum appears to be swollen with increased signal intensity. b) The ADC map shows low-signal intensity in the posterior watershed areas, as well as the splenium of the corpus callosum and the optic radiation
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Fig3: Full-term infant with watershed pattern of injury. Born with severe anaemia (Hb 2.2 mmol/l) following fetomaternal transfusion and a short period of hypoglycaemia (<1.1 mmol/l). Loss of cortical ribbon is noted on the T2SE (TR 6284/TE 120; a), and the corpus callosum appears to be swollen with increased signal intensity. b) The ADC map shows low-signal intensity in the posterior watershed areas, as well as the splenium of the corpus callosum and the optic radiation

Mentions: Watershed predominant pattern of injury (WS) is the other pattern of injury which is also referred to as a pattern seen following ‘prolonged partial asphyxia’. The vascular watershed zones (anterior–middle cerebral artery and posterior–middle cerebral artery) are involved, affecting white matter and in more severely affected infants also the overlying cortex (Fig. 3). The lesions can be uni- or bilateral, posterior and/or anterior. Although loss of the cortical ribbon and therefore the grey–white matter differentiation can be seen on conventional MRI, DWI highlights the abnormalities and is especially helpful in making an early diagnosis [26, 27]. A repeat MRI may show cystic evolution, but more often atrophy and gliotic changes will be recognised [28]. It is also more common after hypotension, infection and hypoglycaemia, all of which may be associated with a more protracted course [29]. Neurological manifestations at birth may be mild and do not always meet the perinatal asphyxia criteria and onset of neurological signs can be delayed [30]. Severe motor impairment is uncommon in this group of infants, and they are often considered to have an early normal outcome, when seen at 12–18 months. When seen up till early childhood suboptimal head growth, behavioural problems and delay in language are, however, common [31, 32]. Miller et al. [33] were first able to recognise cognitive deficits associated with the watershed pattern of injury at 30 months, while the problems were largely overlooked, when seen at 12 months. More recently, they also showed a correlation with verbal IQ at 4 years of age [32]. Symptomatic parieto-occipital epilepsy may occur later in childhood, often associated with reduced intelligence quotients and visuospatial cognitive functions [34].Fig. 3


Patterns of neonatal hypoxic-ischaemic brain injury.

de Vries LS, Groenendaal F - Neuroradiology (2010)

Full-term infant with watershed pattern of injury. Born with severe anaemia (Hb 2.2 mmol/l) following fetomaternal transfusion and a short period of hypoglycaemia (<1.1 mmol/l). Loss of cortical ribbon is noted on the T2SE (TR 6284/TE 120; a), and the corpus callosum appears to be swollen with increased signal intensity. b) The ADC map shows low-signal intensity in the posterior watershed areas, as well as the splenium of the corpus callosum and the optic radiation
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2872019&req=5

Fig3: Full-term infant with watershed pattern of injury. Born with severe anaemia (Hb 2.2 mmol/l) following fetomaternal transfusion and a short period of hypoglycaemia (<1.1 mmol/l). Loss of cortical ribbon is noted on the T2SE (TR 6284/TE 120; a), and the corpus callosum appears to be swollen with increased signal intensity. b) The ADC map shows low-signal intensity in the posterior watershed areas, as well as the splenium of the corpus callosum and the optic radiation
Mentions: Watershed predominant pattern of injury (WS) is the other pattern of injury which is also referred to as a pattern seen following ‘prolonged partial asphyxia’. The vascular watershed zones (anterior–middle cerebral artery and posterior–middle cerebral artery) are involved, affecting white matter and in more severely affected infants also the overlying cortex (Fig. 3). The lesions can be uni- or bilateral, posterior and/or anterior. Although loss of the cortical ribbon and therefore the grey–white matter differentiation can be seen on conventional MRI, DWI highlights the abnormalities and is especially helpful in making an early diagnosis [26, 27]. A repeat MRI may show cystic evolution, but more often atrophy and gliotic changes will be recognised [28]. It is also more common after hypotension, infection and hypoglycaemia, all of which may be associated with a more protracted course [29]. Neurological manifestations at birth may be mild and do not always meet the perinatal asphyxia criteria and onset of neurological signs can be delayed [30]. Severe motor impairment is uncommon in this group of infants, and they are often considered to have an early normal outcome, when seen at 12–18 months. When seen up till early childhood suboptimal head growth, behavioural problems and delay in language are, however, common [31, 32]. Miller et al. [33] were first able to recognise cognitive deficits associated with the watershed pattern of injury at 30 months, while the problems were largely overlooked, when seen at 12 months. More recently, they also showed a correlation with verbal IQ at 4 years of age [32]. Symptomatic parieto-occipital epilepsy may occur later in childhood, often associated with reduced intelligence quotients and visuospatial cognitive functions [34].Fig. 3

Bottom Line: Enormous progress has been made in assessing the neonatal brain, using magnetic resonance imaging (MRI).In this review, we will describe the use of MRI and proton magnetic resonance spectroscopy in detecting different patterns of brain injury in (full-term) human neonates following hypoxic-ischaemic brain injury and indicate the relevance of these findings in predicting neurodevelopmental outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands. l.s.devries@umcutrecht.nl

ABSTRACT
Enormous progress has been made in assessing the neonatal brain, using magnetic resonance imaging (MRI). In this review, we will describe the use of MRI and proton magnetic resonance spectroscopy in detecting different patterns of brain injury in (full-term) human neonates following hypoxic-ischaemic brain injury and indicate the relevance of these findings in predicting neurodevelopmental outcome.

Show MeSH
Related in: MedlinePlus