Neonatal hypoxic-ischemic encephalopathy

Case contributed by Dr Yair Glick

Presentation

Newborn with hypoxic-ischemic encephalopathy due to abruptio placentae.

Patient Data

Age: Neonate (< 1 week)
Gender: Male

Caput succedaneum.

DWI shows global ischemia in both cerebral hemispheres. Cerebral edema with resultant narrowed ventricles and sulci and barely discernible supratentorial cisterns. The superior portion of the brainstem and the superior aspect of the vermis are ischemic as well. The cerebellar hemispheres, pons and medulla appear normal.

Negative lactate peak at 1.4 ppm on MRS (not shown).

No parenchymal hematoma.   A small subdural hematoma can be missed on SWI.

Normal signal in all the large intracranial vessels.

Case Discussion

Term newborn delivered by urgent cesarean section due to abruptio placentae. Low Apgar score. Presented with hypoxic-ischemic encephalopathy manifesting as hypotonia, severe metabolic acidosis, hyponatremia and transient tachypnea of newborn (TTN). Underwent 72-hour whole-body cooling. Cerebral function monitoring (CFM) displayed a very low trace. Later, slight brain activity was seen, partly as seizures and partly as burst suppression. Due to convulsions, both clinical and electrical, he received several anticonvulsants which were gradually discontinued. EEG displayed flattening of electrical brain activity without any epileptic activity.

MRI showed severe global cerebral ischemia with edema.

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Case information

rID: 73238
Published: 2nd Jan 2020
Last edited: 2nd Jan 2020
Inclusion in quiz mode: Included
Institution: Laniado Hospital

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