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Term Hypoxic Ischemic Injury
P. Ellen Grant, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Hypoxic-ischemic injury (HII), hypoxic-ischemic encephalopathy (HIE)
          • Synonyms

            • Hypoxic-ischemic insult, perinatal or birth asphyxia, asphyxia neonatorum
          • Definitions

            • HII: Imaging pattern of injury due to acquired global arterial hypoperfusion (though many factors can increase vulnerability and potential injury)
              • Not all with HII meet clinical criteria for HIE
            • HIE: Clinical syndrome defined in term or near-term neonates
              • Not all with HIE have HII on imaging
            • Profound HII: Complete or nearly complete cessation of blood flow to brain
            • Partial HII: Less severe reduction of cerebral blood flow

          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

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Bell E et al: Magnetic resonance imaging (MRI) and prognostication in neonatal hypoxic-ischemic injury: a vignette-based study of Canadian specialty physicians. J Child Neurol. 30(2):174-81, 2015
                                        2. Orman G et al: Neonatal head ultrasonography today: a powerful imaging tool! J Neuroimaging. 25(1):31-55, 2015
                                        3. 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. Epub ahead of print, 2014
                                        4. Dinan D et al: Easily overlooked sonographic findings in the evaluation of neonatal encephalopathy: lessons learned from magnetic resonance imaging. Semin Ultrasound CT MR. 35(6):627-51, 2014
                                        5. Osmond E et al: Neonatal seizures: magnetic resonance imaging adds value in the diagnosis and prediction of neurodisability. Acta Paediatr. Epub ahead of print, 2014
                                        6. Rollins N et al: Predictive value of neonatal MRI showing no or minor degrees of brain injury after hypothermia. Pediatr Neurol. 50(5):447-51, 2014
                                        7. Skranes JH et al: Hypothermia Makes Cerebral Resistance Index a Poor Prognostic Tool in Encephalopathic Newborns. Neonatology. 106(1):17-23, 2014
                                        8. Coleman MB et al: Neonatal neurobehavioral abnormalities and MRI brain injury in encephalopathic newborns treated with hypothermia. Early Hum Dev. 89(9):733-7, 2013
                                        9. Gano D et al: Evolution of pattern of injury and quantitative MRI on days 1 and 3 in term newborns with hypoxic-ischemic encephalopathy. Pediatr Res. 74(1):82-7, 2013
                                        10. 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
                                        11. Bonifacio SL et al: Therapeutic hypothermia for neonatal encephalopathy results in improved microstructure and metabolism in the deep gray nuclei. AJNR Am J Neuroradiol. 33(11):2050-5, 2012
                                        12. Shankaran S et al: Childhood outcomes after hypothermia for neonatal encephalopathy. N Engl J Med. 366(22):2085-92, 2012
                                        13. Okereafor A et al: Patterns of brain injury in neonates exposed to perinatal sentinel events. Pediatrics. 121(5):906-14, 2008
                                        14. Vermeulen RJ et al: Diffusion-weighted and conventional MR imaging in neonatal hypoxic ischemia: two-year follow-up study. Radiology. 249(2):631-9, 2008
                                        15. Winter JD et al: Apparent diffusion coefficient pseudonormalization time in neonatal hypoxic-ischemic encephalopathy. Pediatr Neurol. 37(4):255-62, 2007
                                        16. 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
                                        17. Ferriero DM: Neonatal brain injury. N Engl J Med. 351(19):1985-95, 2004
                                        18. McKinstry RC et al: A prospective, longitudinal diffusion tensor imaging study of brain injury in newborns. Neurology. 59(6):824-33, 2002
                                        19. Barkovich AJ et al: Proton spectroscopy and diffusion imaging on the first day of life after perinatal asphyxia: preliminary report. AJNR Am J Neuroradiol. 22(9):1786-94, 2001
                                        20. Barkovich AJ et al: Perinatal asphyxia: MR findings in the first 10 days. AJNR Am J Neuroradiol. 16(3):427-38, 1995
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Hypoxic-ischemic injury (HII), hypoxic-ischemic encephalopathy (HIE)
                                                • Synonyms

                                                  • Hypoxic-ischemic insult, perinatal or birth asphyxia, asphyxia neonatorum
                                                • Definitions

                                                  • HII: Imaging pattern of injury due to acquired global arterial hypoperfusion (though many factors can increase vulnerability and potential injury)
                                                    • Not all with HII meet clinical criteria for HIE
                                                  • HIE: Clinical syndrome defined in term or near-term neonates
                                                    • Not all with HIE have HII on imaging
                                                  • Profound HII: Complete or nearly complete cessation of blood flow to brain
                                                  • Partial HII: Less severe reduction of cerebral blood flow

                                                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

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Bell E et al: Magnetic resonance imaging (MRI) and prognostication in neonatal hypoxic-ischemic injury: a vignette-based study of Canadian specialty physicians. J Child Neurol. 30(2):174-81, 2015
                                                                              2. Orman G et al: Neonatal head ultrasonography today: a powerful imaging tool! J Neuroimaging. 25(1):31-55, 2015
                                                                              3. 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. Epub ahead of print, 2014
                                                                              4. Dinan D et al: Easily overlooked sonographic findings in the evaluation of neonatal encephalopathy: lessons learned from magnetic resonance imaging. Semin Ultrasound CT MR. 35(6):627-51, 2014
                                                                              5. Osmond E et al: Neonatal seizures: magnetic resonance imaging adds value in the diagnosis and prediction of neurodisability. Acta Paediatr. Epub ahead of print, 2014
                                                                              6. Rollins N et al: Predictive value of neonatal MRI showing no or minor degrees of brain injury after hypothermia. Pediatr Neurol. 50(5):447-51, 2014
                                                                              7. Skranes JH et al: Hypothermia Makes Cerebral Resistance Index a Poor Prognostic Tool in Encephalopathic Newborns. Neonatology. 106(1):17-23, 2014
                                                                              8. Coleman MB et al: Neonatal neurobehavioral abnormalities and MRI brain injury in encephalopathic newborns treated with hypothermia. Early Hum Dev. 89(9):733-7, 2013
                                                                              9. Gano D et al: Evolution of pattern of injury and quantitative MRI on days 1 and 3 in term newborns with hypoxic-ischemic encephalopathy. Pediatr Res. 74(1):82-7, 2013
                                                                              10. 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
                                                                              11. Bonifacio SL et al: Therapeutic hypothermia for neonatal encephalopathy results in improved microstructure and metabolism in the deep gray nuclei. AJNR Am J Neuroradiol. 33(11):2050-5, 2012
                                                                              12. Shankaran S et al: Childhood outcomes after hypothermia for neonatal encephalopathy. N Engl J Med. 366(22):2085-92, 2012
                                                                              13. Okereafor A et al: Patterns of brain injury in neonates exposed to perinatal sentinel events. Pediatrics. 121(5):906-14, 2008
                                                                              14. Vermeulen RJ et al: Diffusion-weighted and conventional MR imaging in neonatal hypoxic ischemia: two-year follow-up study. Radiology. 249(2):631-9, 2008
                                                                              15. Winter JD et al: Apparent diffusion coefficient pseudonormalization time in neonatal hypoxic-ischemic encephalopathy. Pediatr Neurol. 37(4):255-62, 2007
                                                                              16. 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
                                                                              17. Ferriero DM: Neonatal brain injury. N Engl J Med. 351(19):1985-95, 2004
                                                                              18. McKinstry RC et al: A prospective, longitudinal diffusion tensor imaging study of brain injury in newborns. Neurology. 59(6):824-33, 2002
                                                                              19. Barkovich AJ et al: Proton spectroscopy and diffusion imaging on the first day of life after perinatal asphyxia: preliminary report. AJNR Am J Neuroradiol. 22(9):1786-94, 2001
                                                                              20. Barkovich AJ et al: Perinatal asphyxia: MR findings in the first 10 days. AJNR Am J Neuroradiol. 16(3):427-38, 1995