Term Hypoxic Ischemic Injury Joseph Junewick, MD FACR
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1 Term Hypoxic Ischemic Injury Joseph Junewick, MD FACR 08/11/2010 History Term infant with perinatal distress and attempted forceps delivery. Diagnosis Term Hypoxic Ischemic Injury Discussion Encephalopathy due to hypoxic-ischemic injury usually manifests within the first few hours after birth. A clinical history that includes a low Apgar score, need for resuscitation, decreased cord arterial ph level, other organ failure, respiratory failure, or some combination of these factors increases the level of confidence in a diagnosis of hypoxic-ischemic injury. Neonates are able to tolerate short duration hypoxic-ischemic events. Prolonged hypoxia or hypoperfusion result in watershed injury; the intervascular zones between the anterior and middle cerebral arteries and the middle and posterior cerebral arteries represent the vulnerable zones in the term neonate. Autoregulation provides relative protection of the metabolically active tissues in the brain of the term neonate which are most susceptible to injury including the lateral thalami, posterior putamina, hippocampi, brainstem, corticospinal tracts, and the sensorimotor cortex. On CT this is manifested by hypodensity, loss of junctional differentiation and/or petichial hemorrhage. On MR cytotoxic edema is demonstrated by increased T2 signal and restricted diffusion in the cortex and subcortical white matter. MR spectroscopy reveals increased lactate concentration. Findings CT-Posterior cerebral hypodensity with loss of junctional differentiation. Note the occasional punctate hyperdensity representing hemorrhage. MR-Sagittal T1 demonstrates extensive junctional and deep white matter hemorrhage. Axial and coronal T2 images confirm areas of hemorrhage but also show poor delineation of the cortical gray matter ribbon and extensive white matter edema. Reference Chao CP, Zaleski CG, Patton AC. Neonatal Hypoxic-Ischemic Encephalopathy: Multimodality Imaging Findings. Radiographics (2006); 26:S159-S172. Shroff MM, Soares-Fernandes JP, Whyte H, Raybaud C. MR Imaging for Diagnostic Evaluation of Encephalopathy in the Newborn. Radiographics (2010); 30:
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