MR Patterns of Hypoxic-Ischemic Brain Damage After Prenatal, Perinatal or Postnatal Asphyxia*

Sie, L.T.L.; Knaap, Marjo S. van der; Oosting, J.; Vries, L.S. de; Lafeber, H N; Valk, Jacob

doi:10.1055/s-2000-7496

Cited by 200 publications

(130 citation statements)

References 33 publications

(56 reference statements)

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“…It is also observed by Sie U et al, 6 where PV leukomalacia in 82% after subacute or chronic hypoxia and in preterm babies.…”

Section: Severity Of Involvementsupporting

confidence: 61%

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Hypoxic Ischaemic Encephalopathy: Assessment of Severity by MR Imaging

Arimbrathodi¹,

Rajendran²,

Thottath³

et al. 2016

jemds

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CONTEXTPerinatal asphyxia happens in 2 to 10 per 1000 newborns that are born at term, and more for those that are born prematurely and making one of the leading cause of death worldwide. AIMTo study the pattern of involvement of brain in HIE influenced by nature of insult and to assess the severity of brain injury by MR imaging and correlate with clinical staging (Sarnat criteria). METHODOLOGY43 cases with history of perinatal asphyxia were included in this study by applying the inclusion criteria and exclusion criteria. Signal changes in T1 and T2 weighted images and diffusion weighted were assessed and recorded. RESULTS AND INTERPRETATIONSAfter MR imaging, most of the Sarnat Stage I and II patients were mild and stage III patients were severe. Of the all clinically diagnosed having HIE, 25.6% cases were normal. Patients with clinically mild hypotension >1/2 (54.2%) of them were found to be normal after imaging. Patients with clinically moderate hypotension, 20% were normal at MRI; and >1/2 (52%) of them showed only mild changes and 12% showed severe involvement. Term babies with mild encephalopathy shows more involvement of periventricular white matter than subcortical white matter. Clinically severe encephalopathy correlates with abnormal basal ganglia -thalamic lesions in term babies and germinal matrix haemorrhage in preterm babies. Clinically moderate encephalopathy correlates with signal changes in posterior limb of internal capsule and perirolandic white matter. Prematurity increases the susceptibility of brain to changes caused by hypoxia. No significant association noted between sex and birth weight with abnormal MR imaging findings. The low Apgar score shows significant association with severity of brain involvement. Seizure and its onset also appears to be a deciding parameter in severity of brain injury.

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“…It is also observed by Sie U et al, 6 where PV leukomalacia in 82% after subacute or chronic hypoxia and in preterm babies.…”

Section: Severity Of Involvementsupporting

confidence: 61%

“…In the study by Sie U et al, 6 also found that multicystic encephalopathy in 70% preceded by mild hypoxic ischaemia. It is observed that those babies having profound asphyxia (Stage III), 50% showed involvement of thalamus, 25% showed involvement of basal ganglia and 25% showed involvement of brainstem.…”

Section: Severity Of Involvementmentioning

confidence: 99%

Hypoxic Ischaemic Encephalopathy: Assessment of Severity by MR Imaging

Arimbrathodi¹,

Rajendran²,

Thottath³

et al. 2016

jemds

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“…On early (Յ4 days) PWI-MRI, marked hyperperfusion (increased rCBF and rCBV) was seen in areas of HI brain damage, allowing for classification of the children into the different known patterns of HI injury (1,13,14): 1 infant demonstrated a normal pattern (patient 1); 1 a watershed pattern (patient 2); 1 a basal ganglia pattern (patient 3); and 2 a total cortical pattern (patients 4 and 5). These patterns were confirmed on early diffusionweighted imaging (DWI), on late (9 to 11 days) conventional MRI (T2-weighted images) or on postmortem examination in all infants.…”

Section: Resultsmentioning

confidence: 99%

Perfusion‐weighted magnetic resonance imaging patterns of hypoxic–ischemic encephalopathy in term neonates

Wintermark¹,

Moessinger²,

Gudinchet³

et al. 2008

Magnetic Resonance Imaging

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Purpose:To determine whether an early magnetic resonance imaging (MRI) study using perfusion-weighted imaging (PWI) may define the pattern of brain injury in term neonatal hypoxic-ischemic (HI) encephalopathy. Materials and Methods:Five newborns with HI encephalopathy or a marker of perinatal depression, and 2 controls underwent an early MRI (at 2 to 4 days), including PWI. Relative cerebral blood flow (rCBF) values were measured.Results: On early (Յ4 days) PWI-MRI, marked hyperperfusion was seen in areas of HI brain damage, allowing the classification of the children into different patterns according to the predominant site of injury: 1 with a "normal pattern"; 1 with a "watershed pattern" with increased rCBF ratios in white matter; 1 with a "basal ganglia pattern" with increased rCBF ratios in basal ganglia; and 2 with a "total cortical pattern" with increased rCBF ratios in cortical gray matter, white matter, and basal ganglia. These patterns were confirmed in all infants on late (9 to 11 days) conventional MRI (T2-weighted images) (4 of 5 patients) or on postmortem examination (1 of 5 patients). Conclusion:PWI is technically feasible in neonates with HI encephalopathy in a reproducible way, permitting comparisons between children. It provides a practical means to identify early after birth the future definitive ischemic areas that may be shown on conventional MRI only later. MAGNETIC RESONANCE IMAGING (MRI) is increasingly being used to better understand the heterogeneity of hypoxic-ischemic (HI) brain injury associated with neonatal encephalopathy. Patterns of brain injury in term neonatal encephalopathy have thus been determined and have been associated with different clinical presentations and neurodevelopmental outcomes (1). The pathophysiologic explanation for these different patterns remains unclear, but alterations of cerebral perfusion may be a major factor. Perfusionweighted imaging (PWI) has been used only occasionally in newborns so far (2-4). Furthermore, brain perfusion associated with these different patterns of neonatal encephalopathy has received little attention.The aim of this study was to assess brain perfusion patterns in term newborn infants with HI encephalopathy early after birth, in order to determine whether PWI correlates with the pattern of injury in neonatal encephalopathy observed later by conventional imaging. MATERIALS AND METHODSWe studied 5 term newborn infants who had neonatal HI encephalopathy or a marker of perinatal depression: seizures within 72 hours of birth or at least three of the following criteria: (1) late decelerations on fetal monitoring; (2) umbilical artery pH Ͻ 7.1; (3) 5-minute Apgar score Յ5; or (4) multiorgan failure. These inclusion criteria were chosen, according to previous studies (1,5), to encompass the entire range of neonatal encephalopathy, from normal to severe patterns. The infants underwent an early (range 2 to 4 days) complete magnetic resonance imaging (MRI) study (conventional MRI, perfusion-weighted imaging, and diffusion-weighted imaging) a...

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“…We did not include infants with WM damage only as it is less likely that this pattern results from acute perinatal hypoxia-ischemia alone. 1,28,30 We know that in children with a history of HIE and WM damage in the absence of BGT injury the rate of CP and death is very low; in a study of 46 such infants none died, only 6 developed CP, and all but 2 were walking by 2 years. 31 We also excluded infants treated with hypothermia as at the start of this study it was not known whether this therapy might alter the relationship between imaging and outcome.…”

Section: Discussionmentioning

confidence: 99%

Predicting motor outcome and death in term hypoxic-ischemic encephalopathy

Martinez‐Biarge

Díez‐Sebastián²,

Kapellou³

et al. 2011

Neurology

217

176

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Objectives: Central gray matter damage, the hallmark of term acute perinatal hypoxia-ischemia, frequently leads to severe cerebral palsy and sometimes death. The precision with which these outcomes can be determined from neonatal imaging has not been fully explored. We evaluated the accuracy of early brain MRI for predicting death, the presence and severity of motor impairment, and ability to walk at 2 years in term infants with hypoxic-ischemic encephalopathy (HIE) and basal ganglia-thalamic (BGT) lesions. From 1993From to 2007 term infants with evidence of perinatal asphyxia, HIE, and BGT injury seen on early MRI scans were studied. BGT, white matter, posterior limb of the internal capsule (PLIC), and cortex and brainstem abnormality were classified by severity. Motor impairment was staged using the Gross Motor Function Classification System. Methods: Results:The severity of BGT lesions was strongly associated with the severity of motor impairment (Spearman rank correlation 0.77; p Ͻ 0.001). The association between white matter, cortical, and brainstem injury and motor impairment was less strong and only BGT injury correlated significantly in a logistic regression model. The predictive accuracy of severe BGT lesions for severe motor impairment was 0.89 (95% confidence interval 0.83-0.96). Abnormal PLIC signal intensity predicted the inability to walk independently by 2 years (sensitivity 0.92, specificity 0.77, positive predictive value 0.88, negative predictive value 0.85). Brainstem injury was the only factor with an independent association with death. Conclusion:We have shown that in term newborns with HIE and BGT injury, early MRI can be used to predict death and specific motor outcomes. Neurology ® 2011;76:2055-2061 GLOSSARY BFMF ϭ Bimanual Fine Motor Function; BGT ϭ basal ganglia and thalami; CI ϭ confidence interval; CP ϭ cerebral palsy; GMFCS ϭ Gross Motor Function Classification System; HIE ϭ hypoxic-ischemic encephalopathy; LRM ϭ logistic regression model; NE ϭ neonatal encephalopathy; NPV ϭ negative predictive value; PLIC ϭ posterior limb of the internal capsule; PPV ϭ positive predictive value; SCPE ϭ Surveillance of Cerebral Palsy in Europe; SI ϭ signal intensity; WM ϭ white matter.Central gray matter damage, the hallmark of acute perinatal hypoxia-ischemia in term infants, 1 is an important cause of death and cerebral palsy (CP). CP is a lifelong condition affecting not only motor function, but the child's global development. Commonly associated impairments include learning, visual, feeding, and communication difficulties and epilepsy that all place a heavy burden on the children and their families. Coping with the birth of a severely asphyxiated baby is extremely distressing for parents. Apart from the initial concern that their infant may die, parents have to deal with uncertainty about their child's future. They usually want to know not only if their child will have a motor problem, but its severity and whether their child will be able to walk 3 ; unfortunately, these questions can b...

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MR Patterns of Hypoxic-Ischemic Brain Damage After Prenatal, Perinatal or Postnatal Asphyxia*

Cited by 200 publications

References 33 publications

Hypoxic Ischaemic Encephalopathy: Assessment of Severity by MR Imaging

Hypoxic Ischaemic Encephalopathy: Assessment of Severity by MR Imaging

Perfusion‐weighted magnetic resonance imaging patterns of hypoxic–ischemic encephalopathy in term neonates

Predicting motor outcome and death in term hypoxic-ischemic encephalopathy

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