Learning objectives
Neonatal hypoxic-ischemic encephalopathy (HIE) is a devastating occurrence that may result in death or severe neurologic deficits in children.
The aim of this study is to review the different types and the specific imaging manifestations of hypoxic-ischemic brain lesions.
Background
25% of the world’s newborn deaths are associated with perinatal brain injury resulting from hypoxic-ischemic lesions.
Perinatal asphyxia that may occur either in utero or postnatally,
is the most important cause of HIE.
The exact nature of injury depends on the severity of hypotension and the degree of brain maturation.
Hypoxia-ischemia frequently damages the deep gray matter,
in both preterm and term neonates.
Intraventricular hemorrhages and periventricular white matter injury occur in preterm neonates and parasagittal watershed territory infarcts occur in term neonates.The infant usually...
Findings and procedure details
Patterns of Brain Injury
1.
Preterm neonates
In preterm neonates with immature brain,
periventricular white matter (supplied by ventriculopetal penetrating arteries) is most vulnerable to the HI injury.
Mild to moderate HI injury results in PVL,
that may be focal (adjacent to frontal horns and trigones) or diffuse [Figure 1].
Progressive necrosis results in loss of periventricular white matter,
passive ventriculomegaly (irregular margins of the bodies and trigones of lateral ventricles) and thinning of corpus callosum .
Germinal matrix hemorrhage (GMH) is typically seen in...
Conclusion
HIE is an important cause of morbidity and mortality in the neonatal period.
Cranial US,
CT and MRI show characteristic pattern of brain injury and help to exclude other causes of encephalopathy.
The patterns differ from both that seen in preterm infants and that seen in the adult brain.Correct radiological diagnosis can truly contribute to the efficient implementation of care over the sick child.
References
Bano S,
Chaudhary V,
Garga UC.
Neonatal Hypoxic-ischemic Encephalopathy: A Radiological Review.
J Pediatr Neurosci.
2017 Jan-Mar;12(1):1-6.
doi:10.4103/1817-1745.205646.
Review.
PubMed PMID: 28553370; PubMedCentral PMCID: PMC5437770.
Ferriero DM.
Neonatal brain injury.
N Engl J Med 2004;351:198595.
Shalak L,
Perlman JM.
Hypoxicischemic brain injury in the term infantcurrentconcepts.
Early Hum Dev 2004;80:12541.
Huang BY,
Castillo M.
Hypoxic-ischemic brain injury: imaging findings from birth to adulthood.
Radiographics.
2008 Mar-Apr;28(2):417-39; quiz 617.
doi:10.1148/rg.282075066.
Review.
PubMed PMID: 18349449.
Heinz ER,
Provenzale JM.
Imaging findings in neonatal hypoxia: a practical review....