Answer for CoW 23 April 2017
Severe hypoxic ischaemic encephalopathy in term neonate
Findings
Evidence of T1 Hyperintensity noted in posterior putamen, ventrolateral thalamus, dorsal midbrain and perirolandic region on both sides with loss of normal signal intensity in posterior limb of internal capsule. The same regions shows T2 Hyperintensities and FLAIR Hyperintensities. This regions shows no evidence of diffusion restricted.
Discussion
Imaging finding in term infant with birth asphyxia vary with severity and duration. MRI with DWI is the most sensitive modality. severe HIE in term infants preferentially affects actively myelinating brain and areas of high NMDA receptor activity. The deep grey matter ( posterior putamen, ventrolateral thalamus), Hippocampi and dorsal midbrain are severely affected. T1 and T2 weighted images on day 1 is normal. Between 2 to 3 days later T1 basal ganglia and thalamic hyperintensity with absent or decreased T1 signal in normally myelinated PLIC (posterior limb internal capsule). DWI shows restricted diffusion and low ADC in first 24 hours. Abnormalities peaks at 3 to 4 days and then pseudonormalise at the end of first week.
Findings
Evidence of T1 Hyperintensity noted in posterior putamen, ventrolateral thalamus, dorsal midbrain and perirolandic region on both sides with loss of normal signal intensity in posterior limb of internal capsule. The same regions shows T2 Hyperintensities and FLAIR Hyperintensities. This regions shows no evidence of diffusion restricted.
Discussion
Imaging finding in term infant with birth asphyxia vary with severity and duration. MRI with DWI is the most sensitive modality. severe HIE in term infants preferentially affects actively myelinating brain and areas of high NMDA receptor activity. The deep grey matter ( posterior putamen, ventrolateral thalamus), Hippocampi and dorsal midbrain are severely affected. T1 and T2 weighted images on day 1 is normal. Between 2 to 3 days later T1 basal ganglia and thalamic hyperintensity with absent or decreased T1 signal in normally myelinated PLIC (posterior limb internal capsule). DWI shows restricted diffusion and low ADC in first 24 hours. Abnormalities peaks at 3 to 4 days and then pseudonormalise at the end of first week.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!