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Hypoxic Ischemic Encephalopathy

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Hypoxic ischemic encephalopathy DWI and ADC MRI images
Hypoxic ischemic encephalopathy DWI and ADC MRI images

Hypoxic- 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
  • Brainstem involvement
  • Cerebellar involvement

DICOM scrollable case

 References and further reading:

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