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Hypoxic Ischemic Encephalopathy

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Hypoxic ischemic encephalopathy Radiology

Hypoxic- Ischemic Encephalopathy

  • 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 greatest energy demands.
  • Mild to moderate ischemic insult: Watershed territory infarcts.
  • Severe ischemic insult:
    • Basal ganglia and thalami.
    • Cerebral cortex
    • Cerebellum
    • Hippocampi
  • Changes seen earliest on DWI (few hours) as areas of restricted diffusion.
  • T2W images positive in early subacute period (24 hours–2 weeks),
  • DWI can pseudonormalize by the end of the 1st week while T2W abnormalities persist.
  • 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
  • Brainstem involvement
  • Cerebellar involvement


Case Courtesy
BK Diagnostic Center

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