“ Due to an ischaemic injury in the term neonate. Affects less than 0.5% of live births. Severe ischaemia affects the deep grey matter (puta...
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Due to an ischaemic injury in the term neonate. Affects less than 0.5% of live births. Severe ischaemia affects the deep grey matter (putamen, thalami, hippocampi, dorsal brainstem and lateral geniculate nuclei) predominantly, due to its energy demands. Mild to moderate ischaemia tends to spare deep grey matter at the expense of the cortex and white matter.
US
• Most sensitive 1 week post-injury.
• Look for diffusely increased echogenicity, effaced CSF spaces (i.e. oedema) and increased echogenicity in the deep grey matter.
• Look for multiple cysts following devastating Hypoxic-ischemic encephalopathy—‘multicystic encephalomalacia’.
MRI
• DWI is most sensitive for detecting areas of acute (3-5 days) ischaemia—sensitivity recedes after 1 week.
• T1 and T2 imaging most useful 1 week after injury (look for foci of T2 hyperintensity)—before 1 week, expect foci of high T1 and high T2 signal.
• Expect a thinned cortex and white matter loss long term.
• Expect a thinned cortex and white matter loss long term.
Unenhanced axial CT scan of a term neonate showing diffuse cerebral oedema and loss of grey-white matter differentiation. There are bilateral symmetrical infarcts of the putamen, consistent with hypoxic ischaemic brain injury.
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