Neonatal hypoxic-ischemic encephalopathy
36 weeks newborn, showing flacidity and diminished reflexes with overall reduced Apgar score. History of prenatal distress and emergency CS. Post natal cranial US showed parenchymal abnormality and patient referred for further MRI assessment.
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Diffuse white matter changes involving the subcortical and deep white matter more at the frontal and occipital regions. There is a profound injury to the whole corpus callosum that shows diffusion restriction on DWI and low ADC values. There is sparing of the cortical and deep grey matter structures, including the basal nuclei. There are also two tiny right frontal foci of petechial hemorrhage seen as blooming foci on GRE.
The findings described above of white matter injury with sparing of the cortex, deep grey matter and cerebellar hemispheres point to moderate degree neonatal hypoxic ischemic encephalopathy in a preterm newborn child. The striking diffusion restriction of the corpus callosum has a bad prognostic value. The key to understand the different patterns of neonatal hypoxia is understanding the stages of brain maturation and correlating them with the gestational age of the neonate. The developing areas of the brain are more active metabolically and hence more liable to ischemia.