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Magnetic resonance imaging spectrum of perinatal hypoxic-ischemic brain injury

View Article: PubMed Central - PubMed

ABSTRACT

Perinatal hypoxic–ischemic brain injury results in neonatal hypoxic–ischemic encephalopathy and serious long-term neurodevelopmental sequelae. Magnetic resonance imaging (MRI) of the brain is an ideal and safe imaging modality for suspected hypoxic–ischemic injury. The pattern of injury depends on brain maturity at the time of insult, severity of hypotension, and duration of insult. Time of imaging after the insult influences the imaging findings. Mild to moderate hypoperfusion results in germinal matrix hemorrhages and periventricular leukomalacia in preterm neonates and parasagittal watershed territory infarcts in full-term neonates. Severe insult preferentially damages the deep gray matter in both term and preterm infants. However, associated frequent perirolandic injury is seen in term neonates. MRI is useful in establishing the clinical diagnosis, assessing the severity of injury, and thereby prognosticating the outcome. Familiarity with imaging spectrum and insight into factors affecting the injury will enlighten the radiologist to provide an appropriate diagnosis.

No MeSH data available.


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A 76-day-old infant born preterm (30 weeks + 4 days) with maternal h/o pre-eclampsia and born by lower segment Cesarian section (LSCS) shows mild-to-moderate hypoxic ischemic injury to the brain. (A) Axial T2WI at the level of lateral ventricles shows germinal matrix hemorrhage at right caudothalamic groove (black arrow). (B) Axial FLAIR image at the level of lateral ventricles shows left periventricular white matter cyst (white arrow)
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Figure 4: A 76-day-old infant born preterm (30 weeks + 4 days) with maternal h/o pre-eclampsia and born by lower segment Cesarian section (LSCS) shows mild-to-moderate hypoxic ischemic injury to the brain. (A) Axial T2WI at the level of lateral ventricles shows germinal matrix hemorrhage at right caudothalamic groove (black arrow). (B) Axial FLAIR image at the level of lateral ventricles shows left periventricular white matter cyst (white arrow)

Mentions: DWI usually show early restriction of diffusion (after 24 hours of birth) and pseudonormalize within 5–7 days. Usually by 3–4 days, early white matter injury causes reactive astrogliosis and manifests as periventricular foci of T1 hyperintensity (without corresponding T2 hypointensity). Subsequently, by 6–7 days, these foci show mild reduction in T2 signal intensity. In contrast, hemorrhage manifests as T2 hypointensity initially itself and show blooming artifact on T2* or SWI. By 2–6 weeks of age, some cases show periventricular cysts (cystic variant) [Figures 3 and 4] and end-stage PVL occurs by 6 months of life.


Magnetic resonance imaging spectrum of perinatal hypoxic-ischemic brain injury
A 76-day-old infant born preterm (30 weeks + 4 days) with maternal h/o pre-eclampsia and born by lower segment Cesarian section (LSCS) shows mild-to-moderate hypoxic ischemic injury to the brain. (A) Axial T2WI at the level of lateral ventricles shows germinal matrix hemorrhage at right caudothalamic groove (black arrow). (B) Axial FLAIR image at the level of lateral ventricles shows left periventricular white matter cyst (white arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036328&req=5

Figure 4: A 76-day-old infant born preterm (30 weeks + 4 days) with maternal h/o pre-eclampsia and born by lower segment Cesarian section (LSCS) shows mild-to-moderate hypoxic ischemic injury to the brain. (A) Axial T2WI at the level of lateral ventricles shows germinal matrix hemorrhage at right caudothalamic groove (black arrow). (B) Axial FLAIR image at the level of lateral ventricles shows left periventricular white matter cyst (white arrow)
Mentions: DWI usually show early restriction of diffusion (after 24 hours of birth) and pseudonormalize within 5–7 days. Usually by 3–4 days, early white matter injury causes reactive astrogliosis and manifests as periventricular foci of T1 hyperintensity (without corresponding T2 hypointensity). Subsequently, by 6–7 days, these foci show mild reduction in T2 signal intensity. In contrast, hemorrhage manifests as T2 hypointensity initially itself and show blooming artifact on T2* or SWI. By 2–6 weeks of age, some cases show periventricular cysts (cystic variant) [Figures 3 and 4] and end-stage PVL occurs by 6 months of life.

View Article: PubMed Central - PubMed

ABSTRACT

Perinatal hypoxic–ischemic brain injury results in neonatal hypoxic–ischemic encephalopathy and serious long-term neurodevelopmental sequelae. Magnetic resonance imaging (MRI) of the brain is an ideal and safe imaging modality for suspected hypoxic–ischemic injury. The pattern of injury depends on brain maturity at the time of insult, severity of hypotension, and duration of insult. Time of imaging after the insult influences the imaging findings. Mild to moderate hypoperfusion results in germinal matrix hemorrhages and periventricular leukomalacia in preterm neonates and parasagittal watershed territory infarcts in full-term neonates. Severe insult preferentially damages the deep gray matter in both term and preterm infants. However, associated frequent perirolandic injury is seen in term neonates. MRI is useful in establishing the clinical diagnosis, assessing the severity of injury, and thereby prognosticating the outcome. Familiarity with imaging spectrum and insight into factors affecting the injury will enlighten the radiologist to provide an appropriate diagnosis.

No MeSH data available.


Related in: MedlinePlus