Hypoxic ischemic encephalopathy DWI and ADC MRI imagesHypoxic- Ischemic Encephalopathy (HIE)
Pathophysiology of HIE
- Causes in adults:
- Drowning
- Asphyxiation
- Cardiac arrest
- Cerebrovascular accident
- Selectively vulnerable areas of the brain: For detailed pathophysiology cascade click here.
- Areas with highest concentrations of glutamate or other excitatory amino acid receptors
- Areas of the brain with the greatest energy demands.
- Mild to moderate ischemic insult: Watershed territory infarcts.
- Severe ischemic insult:Basal ganglia and thalami.
- Cerebral cortex
- Cerebellum
- Hippocampi
Imaging features of Hypoxic ischemic encephalopathy
- Changes are seen earliest on DWI (few hours) as areas of restricted diffusion.
- T2W images positive in the early subacute period (24 hours–2 weeks),
- DWI can pseudonormalize by the end of the 1st week while T2W abnormalities persist.
- The outcome is relatively poor.
| Imaging findings associated with relatively better outcome: |
Imaging findings associated with relatively poor outcome: |
- Watershed pattern
- Basal ganglia pattern without cortical involvement
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- Brainstem involvement
- Cerebellar involvement
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DICOM scrollable case
References and further reading:
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