Patterns of neonatal hypoxic–ischaemic brain injury

Neonatal hypoxic ischaemic brain injuries can manifest in different patterns of involvement depending on the severity and timing of the insult. When considering the perinatal maturation process of the brain and the severity of an insult, it is possible to understand the various manifestations.

Typical patterns relative to timing of insult are as follows, with each condition described in detail in separate articles. 

  • before 28 weeks
    • hydranencephaly and porencephaly
      • the immature brain is not able to react with gliosis
      • liquefied brain parenchymal defect and enlargement of CSF spaces. Usually without hyperintensities on FLAIR
  • 28 to 32 weeks
    • periventricular-intraventricular haemorrhage (PIVH)
      • origin in the subependymal germinal matrix, which is an extremely cellular area that gives rise to neurones and glia during gestation and involutes before term 
      • there is a direct relation between prematurity and number of capillaries in this region
      • the haemorrhages are related to perinatal stress and usually the majority occurs after birth within the first week of life
  • 32 to 36 weeks (pre or perinatal insult in preterm newborns)
    • periventricular leukomalacia (PVL) and subcortical leukomalacia
      • there is some overlap with PIVH
      • bilateral coagulation necrosis with white matter loss, gliosis, and cavitated lesions adjacent to the external angles of lateral ventricles or diffuse white matter injury and hypomyelination
      • both periventricular and subcortical leukomalacia are a continuous disease spectrum: vascular border zones shift towards the periphery as the brain further matures; for this reason, white matter lesions move from the periventricular to the subcortical zone
  • term newborn
    • hypoxic-ischaemic encephalopathy of the term newborn
      • "acute near-total asphyxia" results in lesions in high-oxygen-demand areas 6
        • deep grey matter (basal ganglia and thalamus)
        • cortex (perirolandic cortex)
      • "prolonged partial asphyxia" results in lesions of white and grey matter in a watershed distribution 6
        • can lead to ulegyria, one of the leading causes of posterior cortex epilepsy 5​
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Article information

rID: 35676
Section: Gamuts
Tag: cases
Synonyms or Alternate Spellings:
  • Neonatal hypoxic ischaemic brain injuries

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Cases and figures

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    Case 1: white matter affection in a preterm
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    Case 2: perirolandic injury in full term infant
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