Hypoxic-ischemic encephalopathy in term infants: diagnosis and prognosis evaluated by ultrasound.

Abstract

The results of cranial ultrasonography in 32 term infants who had hypoxic-ischemic encephalopathy (HIE) and in 26 control infants were reviewed. Small or nonvisualized ventricles were present in 94% of the patients with HIE and in 62% of the control subjects. In 20 of the 32 patients (63%) with HIE, ultrasound demonstrated parenchymal abnormalities; the most common finding was periventricular hyperechogenicity (12/32 patients). There was a single false positive result in the control group. Fifty per cent of patients with HIE who had abnormalities demonstrated on ultrasonograms died (within 15 days of birth), whereas none of the infants who had normal ultrasound findings died. Moreover, 80% of surviving patients who had abnormal ultrasound findings had residual neurological deficits versus only 11% of those with normal ultrasound findings. Our results indicate that ultrasound is effective in detecting parenchymal changes in patients with HIE, parenchymal echoes are a more reliable sign of HIE than ventricular size, and the finding of parenchymal lesions on ultrasound scans appears to be predictive of abnormal motor development.

Magnetic resonance imaging in perinatal asphyxia.

“…'1012 However, it has low sensitivity in term babies with HIE, and correlation with spastic diplegia is not good unless cystic lesions are detected, which severely limits its prognostic value. [13][14][15] In several studies the assessment of blood flow velocity in the anterior cerebral artery using Doppler ultrasound scanning has shown a high positive predictive value, but long term follow up has not been done. 16 17 Some authors believe that characteristic postischaemic cerebral lesions can be delineated on computed tomography only beyond the age of 6 months, although the maximum extent of acute cerebral oedema and necrosis has been Magnetic resonance imaging in perinatal asphyxia Because of higher sensitivity and specificity to maturational changes, such as visualisation of myelination and changes in cerebral structures, MRI has had an enormous impact on neurological imaging.20 21 Although expensive and sometimes difficult to perform in acutely ill newborns, MRI overcomes many of the shortcomings of ultrasound scanning and computed tomography.22 23 It has a higher sensitivity and has been extremely valuable in assessing the extent of hypoxic-ischaemic brain damage during the early postnatal period and later infancy.22 2426 It also is more specific, clearly differentiating fluid filled cavities, oedema, gliosis and haemorrhage.…”

Easily Overlooked Sonographic Findings in the Evaluation of Neonatal Encephalopathy: Lessons Learned From Magnetic Resonance Imaging

“…These signs include focally or diffusely increased echogenicity of the brain parenchyma, slitlike ventricles, and obliteration of the extracerebral cerebrospinal fluid spaces and the interhemispheric fissure. [32][33][34] In describing lesser-known US findings in NE, either due to HII or other causes, we reinforce the significant role US can play as a first-line imaging tool, which can be indispensable during the evaluation of critically ill neonates or can complement magnetic resonance imaging (MRI) in more stable neonates. [35][36][37][38][39][40][41] This imaging update draws heavily on the experience of Epelman et al, 39 whose 29-month experience with a cohort of patients with NE receiving concurrent US and MRI guides this discussion.…”

“…33,34 Indistinctness or blurring of the interhemispheric fissures and sylvian fissures also occurs. 37,39 In advanced cases, the expected GWMD is lost.…”

Predictive Significance of Magnetic Resonance Imaging at 4 Months of Adjusted Age in Infants after a Perinatal Neurologic Insult

“…Numerous methods have been proposed to assess early and accurate the diagnosis of the types of lesion in such brain damage including electroencephalography [1], biochemical markers [2,18], cranial ultrasound [1,3,4,19,20], computed tomography [21,22], and MRI [5,15,23]. Transient periventricular echo densities or periventricular leukomalacia are predictive of impaired neurodevelopmental outcome [1,3,4,[24][25][26] as well as ventricular dilatation and cerebral atrophy [19].…”