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Pediatrics
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Brain
Traumatic and Vascular Lesions
Hypoxic-Ischemic Encephalopathy
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, hypoxic-ischemic brain damage, neonatal asphyxia

            • Definitions

              • Hypoxic-ischemic encephalopathy (HIE): Neonatal brain injury caused by perinatal hypoxic-ischemic insult

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. O'Kane A et al: Early versus late brain magnetic resonance imaging after neonatal hypoxic ischemic encephalopathy treated with therapeutic hypothermia. J Pediatr. 232:73-79.e2, 2021
                                      2. Misser SK et al: A pictorial review of the pathophysiology and classification of the magnetic resonance imaging patterns of perinatal term hypoxic ischemic brain injury - what the radiologist needs to know…. SA J Radiol. 24(1):1915, 2020
                                      3. Ouwehand S et al: Predictors of outcomes in hypoxic-ischemic encephalopathy following hypothermia: a meta-analysis. Neonatology. 117(4):411-27, 2020
                                      4. 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
                                      5. 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
                                      6. 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
                                      7. 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
                                      8. 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
                                      9. Trivedi SB et al: A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy. Pediatr Radiol. 47(11):1491-9, 2017
                                      10. 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
                                      11. 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
                                      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, hypoxic-ischemic brain damage, neonatal asphyxia

                                                • Definitions

                                                  • Hypoxic-ischemic encephalopathy (HIE): Neonatal brain injury caused by perinatal hypoxic-ischemic insult

                                                IMAGING

                                                • General Features

                                                  • Ultrasonographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Staging, Grading, & Classification

                                                                • Gross Pathologic & Surgical Features

                                                                  CLINICAL ISSUES

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. O'Kane A et al: Early versus late brain magnetic resonance imaging after neonatal hypoxic ischemic encephalopathy treated with therapeutic hypothermia. J Pediatr. 232:73-79.e2, 2021
                                                                          2. Misser SK et al: A pictorial review of the pathophysiology and classification of the magnetic resonance imaging patterns of perinatal term hypoxic ischemic brain injury - what the radiologist needs to know…. SA J Radiol. 24(1):1915, 2020
                                                                          3. Ouwehand S et al: Predictors of outcomes in hypoxic-ischemic encephalopathy following hypothermia: a meta-analysis. Neonatology. 117(4):411-27, 2020
                                                                          4. 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
                                                                          5. 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
                                                                          6. 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
                                                                          7. 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
                                                                          8. 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
                                                                          9. Trivedi SB et al: A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy. Pediatr Radiol. 47(11):1491-9, 2017
                                                                          10. 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
                                                                          11. 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
                                                                          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