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Magnetic resonance imaging spectrum of perinatal hypoxic-ischemic brain injury

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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.

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An 8-month-old infant born late preterm (36 weeks 3 days), small for gestational age with symptomatic hypoglycemia and hypoxic brain injury. (A, B) Axial T1WI at the level of lateral ventricles show cystic changes (c) involving frontal and parietooccipital white matter. Note the predominant involvement of parietooccipital region and cortical thinning (arrows)
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Figure 21: An 8-month-old infant born late preterm (36 weeks 3 days), small for gestational age with symptomatic hypoglycemia and hypoxic brain injury. (A, B) Axial T1WI at the level of lateral ventricles show cystic changes (c) involving frontal and parietooccipital white matter. Note the predominant involvement of parietooccipital region and cortical thinning (arrows)

Mentions: Neonatal hypoglycaemia (<46 mg/dL) can occur in 5 to 15% of normal term neonates. The injury patterns described are white matter abnormalities (most common), cortical abnormalities, white matter hemorrhage, basal ganglia–thalamic lesions, and PLIC abnormalities. A predominant parietooccipital distribution of abnormalities is seen in approximately 30% of the patients [Figure 20].[22] Neonates with hypoxic ischemic encephalopathy (HIE) are at increased risk developing concurrent hypoglycemia [Figure 3]. These neonates show predominant pattern of HII as well as specific imaging features of hypoglycemia [Figure 21]. It is impossible to differentiate hypoglycemic brain injury from HII by imaging alone, unless it is of parietooccipital distribution.


Magnetic resonance imaging spectrum of perinatal hypoxic-ischemic brain injury
An 8-month-old infant born late preterm (36 weeks 3 days), small for gestational age with symptomatic hypoglycemia and hypoxic brain injury. (A, B) Axial T1WI at the level of lateral ventricles show cystic changes (c) involving frontal and parietooccipital white matter. Note the predominant involvement of parietooccipital region and cortical thinning (arrows)
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5036328&req=5

Figure 21: An 8-month-old infant born late preterm (36 weeks 3 days), small for gestational age with symptomatic hypoglycemia and hypoxic brain injury. (A, B) Axial T1WI at the level of lateral ventricles show cystic changes (c) involving frontal and parietooccipital white matter. Note the predominant involvement of parietooccipital region and cortical thinning (arrows)
Mentions: Neonatal hypoglycaemia (<46 mg/dL) can occur in 5 to 15% of normal term neonates. The injury patterns described are white matter abnormalities (most common), cortical abnormalities, white matter hemorrhage, basal ganglia–thalamic lesions, and PLIC abnormalities. A predominant parietooccipital distribution of abnormalities is seen in approximately 30% of the patients [Figure 20].[22] Neonates with hypoxic ischemic encephalopathy (HIE) are at increased risk developing concurrent hypoglycemia [Figure 3]. These neonates show predominant pattern of HII as well as specific imaging features of hypoglycemia [Figure 21]. It is impossible to differentiate hypoglycemic brain injury from HII by imaging alone, unless it is of parietooccipital distribution.

View Article: PubMed Central - PubMed

ABSTRACT

Perinatal hypoxic&ndash;ischemic brain injury results in neonatal hypoxic&ndash;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&ndash;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