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Hypoxic-Ischemic Encephalopathy
Luke L. Linscott, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Hypoxic-ischemic injury (HII)
              • Neonatal asphyxia or birth asphyxia
            • Definitions

              • Hypoxic-ischemic encephalopathy (HIE): Constellation of clinical findings resulting from neonatal brain injury secondary to perinatal hypoxic-ischemic insult

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Razak A et al: Erythropoietin in perinatal hypoxic-ischemic encephalopathy: a systematic review and meta-analysis. J Perinat Med. 47(4):478-89, 2019
                                        2. Salas J et al: The role of diffusion tensor imaging in detecting hippocampal injury following neonatal hypoxic-ischemic encephalopathy. J Neuroimaging. 29(2):252-9, 2019
                                        3. Shetty AN et al: Cerebral oxygen metabolism during and after therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy: a feasibility study using magnetic resonance imaging. Pediatr Radiol. 49(2):224-33, 2019
                                        4. Salas J et al: Head ultrasound in neonatal hypoxic-ischemic injury and its mimickers for clinicians: a review of the patterns of injury and the evolution of findings over time. Neonatology. 114(3):185-97, 2018
                                        5. Weeke LC et al: A novel magnetic resonance imaging score predicts neurodevelopmental outcome after perinatal asphyxia and therapeutic hypothermia. J Pediatr. 192:33-40.e2, 2018
                                        6. Heursen EM et al: Prognostic value of the apparent diffusion coefficient in newborns with hypoxic-ischaemic encephalopathy treated with therapeutic hypothermia. Neonatology. 112(1):67-72, 2017
                                        7. Sánchez Fernández I et al: Prognostic value of brain magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy: a meta-analysis. J Child Neurol. 32(13):1065-73, 2017
                                        8. Trivedi SB et al: A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy. Pediatr Radiol. 47(11):1491-9, 2017
                                        9. Charon V et al: Comparison of early and late MRI in neonatal hypoxic-ischemic encephalopathy using three assessment methods. Pediatr Radiol. 45(13):1988-2000, 2015
                                        10. De Vis JB et al: Arterial spin-labelling perfusion MRI and outcome in neonates with hypoxic-ischemic encephalopathy. Eur Radiol. 25(1):113-21, 2015
                                        11. Douglas-Escobar M et al: Hypoxic-ischemic encephalopathy: a review for the clinician. JAMA Pediatr. 169(4):397-403, 2015
                                        12. Shankaran S et al: Neonatal magnetic resonance imaging pattern of brain injury as a biomarker of childhood outcomes following a trial of hypothermia for neonatal hypoxic-ischemic Encephalopathy. J Pediatr. 167(5):987-93.e3, 2015
                                        13. Cavalleri F et al: Prognostic value of diffusion-weighted imaging summation scores or apparent diffusion coefficient maps in newborns with hypoxic-ischemic encephalopathy. Pediatr Radiol. 44(9):1141-54, 2014
                                        14. Ancora G et al: Prognostic value of brain proton MR spectroscopy and diffusion tensor imaging in newborns with hypoxic-ischemic encephalopathy treated by brain cooling. Neuroradiology. 55(8):1017-25, 2013
                                        15. Harteman JC et al: Placental pathology in full-term infants with hypoxic-ischemic neonatal encephalopathy and association with magnetic resonance imaging pattern of brain injury. J Pediatr. 163(4):968-95.e2, 2013
                                        16. Jose A et al: Correlation of EEG, CT, and MRI brain with neurological outcome at 12 months in term newborns with hypoxic ischemic encephalopathy. J Clin Neonatol. 2(3):125-30, 2013
                                        17. Srinivasakumar P et al: Therapeutic hypothermia in neonatal hypoxic ischemic encephalopathy: electrographic seizures and magnetic resonance imaging evidence of injury. J Pediatr. 163(2):465-70, 2013
                                        18. Bednarek N et al: Impact of therapeutic hypothermia on MRI diffusion changes in neonatal encephalopathy. Neurology. 78(18):1420-7, 2012
                                        19. Mulkey SB et al: Quantitative cranial magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy. Pediatr Neurol. 47(2):101-8, 2012
                                        20. Glass HC et al: Seizures and magnetic resonance imaging-detected brain injury in newborns cooled for hypoxic-ischemic encephalopathy. J Pediatr. 159(5):731-735.e1, 2011
                                        21. Izbudak I et al: MR imaging of the term and preterm neonate with diffuse brain injury. Magn Reson Imaging Clin N Am. 19(4):709-31; vii, 2011
                                        22. Griffiths PD et al: Anatomic localization of dyskinesia in children with "profound" perinatal hypoxic-ischemic injury. AJNR Am J Neuroradiol. 31(3):436-41, 2010
                                        23. Logitharajah P et al: Hypoxic-ischemic encephalopathy in preterm infants: antecedent factors, brain imaging, and outcome. Pediatr Res. 66(2):222-9, 2009
                                        24. Okereafor A et al: Patterns of brain injury in neonates exposed to perinatal sentinel events. Pediatrics. 121(5):906-14, 2008
                                        25. Winter JD et al: Apparent diffusion coefficient pseudonormalization time in neonatal hypoxic-ischemic encephalopathy. Pediatr Neurol. 37(4):255-62, 2007
                                        26. Barkovich AJ et al: MR imaging, MR spectroscopy, and diffusion tensor imaging of sequential studies in neonates with encephalopathy. AJNR Am J Neuroradiol. 27(3):533-47, 2006
                                        27. Miller SP et al: Patterns of brain injury in term neonatal encephalopathy. J Pediatr. 146(4):453-60, 2005
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Pathology

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Hypoxic-ischemic injury (HII)
                                                    • Neonatal asphyxia or birth asphyxia
                                                  • Definitions

                                                    • Hypoxic-ischemic encephalopathy (HIE): Constellation of clinical findings resulting from neonatal brain injury secondary to perinatal hypoxic-ischemic insult

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Ultrasonographic Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  • Gross Pathologic & Surgical Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Razak A et al: Erythropoietin in perinatal hypoxic-ischemic encephalopathy: a systematic review and meta-analysis. J Perinat Med. 47(4):478-89, 2019
                                                                              2. Salas J et al: The role of diffusion tensor imaging in detecting hippocampal injury following neonatal hypoxic-ischemic encephalopathy. J Neuroimaging. 29(2):252-9, 2019
                                                                              3. Shetty AN et al: Cerebral oxygen metabolism during and after therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy: a feasibility study using magnetic resonance imaging. Pediatr Radiol. 49(2):224-33, 2019
                                                                              4. Salas J et al: Head ultrasound in neonatal hypoxic-ischemic injury and its mimickers for clinicians: a review of the patterns of injury and the evolution of findings over time. Neonatology. 114(3):185-97, 2018
                                                                              5. Weeke LC et al: A novel magnetic resonance imaging score predicts neurodevelopmental outcome after perinatal asphyxia and therapeutic hypothermia. J Pediatr. 192:33-40.e2, 2018
                                                                              6. Heursen EM et al: Prognostic value of the apparent diffusion coefficient in newborns with hypoxic-ischaemic encephalopathy treated with therapeutic hypothermia. Neonatology. 112(1):67-72, 2017
                                                                              7. Sánchez Fernández I et al: Prognostic value of brain magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy: a meta-analysis. J Child Neurol. 32(13):1065-73, 2017
                                                                              8. Trivedi SB et al: A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy. Pediatr Radiol. 47(11):1491-9, 2017
                                                                              9. Charon V et al: Comparison of early and late MRI in neonatal hypoxic-ischemic encephalopathy using three assessment methods. Pediatr Radiol. 45(13):1988-2000, 2015
                                                                              10. De Vis JB et al: Arterial spin-labelling perfusion MRI and outcome in neonates with hypoxic-ischemic encephalopathy. Eur Radiol. 25(1):113-21, 2015
                                                                              11. Douglas-Escobar M et al: Hypoxic-ischemic encephalopathy: a review for the clinician. JAMA Pediatr. 169(4):397-403, 2015
                                                                              12. Shankaran S et al: Neonatal magnetic resonance imaging pattern of brain injury as a biomarker of childhood outcomes following a trial of hypothermia for neonatal hypoxic-ischemic Encephalopathy. J Pediatr. 167(5):987-93.e3, 2015
                                                                              13. Cavalleri F et al: Prognostic value of diffusion-weighted imaging summation scores or apparent diffusion coefficient maps in newborns with hypoxic-ischemic encephalopathy. Pediatr Radiol. 44(9):1141-54, 2014
                                                                              14. Ancora G et al: Prognostic value of brain proton MR spectroscopy and diffusion tensor imaging in newborns with hypoxic-ischemic encephalopathy treated by brain cooling. Neuroradiology. 55(8):1017-25, 2013
                                                                              15. Harteman JC et al: Placental pathology in full-term infants with hypoxic-ischemic neonatal encephalopathy and association with magnetic resonance imaging pattern of brain injury. J Pediatr. 163(4):968-95.e2, 2013
                                                                              16. Jose A et al: Correlation of EEG, CT, and MRI brain with neurological outcome at 12 months in term newborns with hypoxic ischemic encephalopathy. J Clin Neonatol. 2(3):125-30, 2013
                                                                              17. Srinivasakumar P et al: Therapeutic hypothermia in neonatal hypoxic ischemic encephalopathy: electrographic seizures and magnetic resonance imaging evidence of injury. J Pediatr. 163(2):465-70, 2013
                                                                              18. Bednarek N et al: Impact of therapeutic hypothermia on MRI diffusion changes in neonatal encephalopathy. Neurology. 78(18):1420-7, 2012
                                                                              19. Mulkey SB et al: Quantitative cranial magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy. Pediatr Neurol. 47(2):101-8, 2012
                                                                              20. Glass HC et al: Seizures and magnetic resonance imaging-detected brain injury in newborns cooled for hypoxic-ischemic encephalopathy. J Pediatr. 159(5):731-735.e1, 2011
                                                                              21. Izbudak I et al: MR imaging of the term and preterm neonate with diffuse brain injury. Magn Reson Imaging Clin N Am. 19(4):709-31; vii, 2011
                                                                              22. Griffiths PD et al: Anatomic localization of dyskinesia in children with "profound" perinatal hypoxic-ischemic injury. AJNR Am J Neuroradiol. 31(3):436-41, 2010
                                                                              23. Logitharajah P et al: Hypoxic-ischemic encephalopathy in preterm infants: antecedent factors, brain imaging, and outcome. Pediatr Res. 66(2):222-9, 2009
                                                                              24. Okereafor A et al: Patterns of brain injury in neonates exposed to perinatal sentinel events. Pediatrics. 121(5):906-14, 2008
                                                                              25. Winter JD et al: Apparent diffusion coefficient pseudonormalization time in neonatal hypoxic-ischemic encephalopathy. Pediatr Neurol. 37(4):255-62, 2007
                                                                              26. Barkovich AJ et al: MR imaging, MR spectroscopy, and diffusion tensor imaging of sequential studies in neonates with encephalopathy. AJNR Am J Neuroradiol. 27(3):533-47, 2006
                                                                              27. Miller SP et al: Patterns of brain injury in term neonatal encephalopathy. J Pediatr. 146(4):453-60, 2005