[P2-137] N eonatal hypoxic ischemic encephalopathy with total brain injury
H ypoxic-ischemic injury (HII) continues to be an important cause for neonatal mortality and morbidity. HII in term newborns has been classified into two main patterns; 1) partial asphyxia caused by mild-moderate hypoxic ischemia, and 2) profound asphyxia caused by severe insult. If the insult leading to profound asphyxia is both severe and of a long duration, the injury is more severe with occasional involvement of the dorsal brainstem and the entire cerebral cortex, referred to as “total brain injury”. Here, we report the clinical course and follow-up imaging findings in 4 term neonates with severe hypoxic ischemia and total brain injury revealed by early brain magnetic resonance imaging (MRI).
The first diffusion-weighted MRI (average day 2.5) showed increased signal intensity throughout all the cortical and subcortical areas, while the cerebellum remained normal (white cerebrum sign) in all the cases. The patients showed prolonged muscle hypotonia and loss of primitive reflexes. The second MRI (average day 12.3) showed necrosis of the basal ganglia and thalamus, while the third MRI (average day 36.5) showed severe brain atrophy and multicystic encephalomalacia in all the cases. All the patients survived and were discharged from our hospital but had severe sequelae, in that, all the patients were immobile, two underwent tracheostomy, one required ventilator support, two required continuous oropharyngeal suction, while three patients required tube feeding.
Neonates with total brain injury showed a characteristic transition in the imaging pattern and had permanent neurological sequelae, including brainstem dysfunction.
The first diffusion-weighted MRI (average day 2.5) showed increased signal intensity throughout all the cortical and subcortical areas, while the cerebellum remained normal (white cerebrum sign) in all the cases. The patients showed prolonged muscle hypotonia and loss of primitive reflexes. The second MRI (average day 12.3) showed necrosis of the basal ganglia and thalamus, while the third MRI (average day 36.5) showed severe brain atrophy and multicystic encephalomalacia in all the cases. All the patients survived and were discharged from our hospital but had severe sequelae, in that, all the patients were immobile, two underwent tracheostomy, one required ventilator support, two required continuous oropharyngeal suction, while three patients required tube feeding.
Neonates with total brain injury showed a characteristic transition in the imaging pattern and had permanent neurological sequelae, including brainstem dysfunction.