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Quiz Prize Rules Current Rankings DIAGNOSIS:
Hypoxic-Ischemic Encephalopathy
The T2W images (Figs. 1, 2) show diffuse, bilaterally symmetrical increased signal in the cerebral cortex and cerebellar folia, as well as the basal ganglia and thalami. The diffusion-weighted images (Figs. 3, 4) show corresponding diffusion restriction in both cerebral and cerebellar hemispheres, basal ganglia and thalami, consistent with cytotoxic edema. The spectroscopy images (Figs. 6, 7) show inverted doublet of lactate at 1.33 ppm with decreased NAA and Cr
These findings are highly suggestive of hypoxic-ischemic encephalopathy.
1) Hypoxic ischemic encephalopathy (HIE) is due to global injury to the brain secondary to perfusion / oxygenation disturbances.
2) Common causes – hypotension, cardiac arrest, neonatal asphyxia, strangulation, smothering, aspiration, drowning, CO inhalation.
3) Patterns of HIE:
a) Cortical border zone infarcts.
b) Deep white matter infarcts (penetrating artery watershed zone).
c) Cortical pseudolaminar necrosis.
d) Predominantly deep gray nuclei.
4) MR spectroscopy
- Has a role in e arly evaluation of white matter injury- increase in lactate and decreased NAA before standard imaging sequences become abnormal.
- Elevated lactate is seen in the first few hours after ischemic injury. If present after 24 hours, lactate is good indicator of permanent brain injury.
- Decrease in NAA, Cr, Cho, myoinositol, NAA/cho.
- Increase in glutamine & glutamate.
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PubMed References for Hypoxic-Ischemic Encephalopathy
At any given time this link will provide references from Pubmed, including the most recent updates. Retrievals are designed to include articles available free and also Indian studies.
The following radiologists have answered this quiz correctly.
Names
Ajitsinh Jemalbhai Vahder
Amogh Hegde
Archana Gupte
Ashutosh Soni
Ashwani Singh Rathor
Chary D
Edmund Moses
Gaurav Goel
Geetanjali Tomar
Girish Kulkarni
Govardhan Maheshwari
Harsh Sadana
Hassan Abdulrahim
Hemant Parmar
Julie Arora
Karunakaran M
Kiran Parmar
Lovkesh Mittal
Manisha Jana
Meghana Aklujkar
Micheal Weber
Nabil Sherif
Ram Prakash Galwa
Rashmi Katre
Ravindra Kundu
Roozbeh Barikbin
Sandeep Singh Bakshi
Sanjeeb Agrawal
Saurabh Khandelwal
Sebastin Varghese
Shalini Sharma
SP Manickam
Sumit Uprety
Sunali Desai
Suresh Thakur
Swati Chinchure
Uday Surana
Vikash Kumar
Visagan.S
Wangju Sumnyan
Yadav Munde
Yogesh Gohil
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