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Term Hypoxic Ischemic Injury

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Vascular
Created: over 10 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: CT MR
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Term infant with perinatal distress and attempted forceps delivery.

Case Images


Term Hypoxic Ischemic Injury


CT – Posterior cerebral hypodensity with loss of junctional differentiation. Note the occasional punctate hyperdensity representing hemorrhage.

MR – Sagittal T1 demonstrates extensive junctional and deep white matter hemorrhage. Axial and coronal T2 images confirm areas of hemorrhage but also show poor delineation of the cortical gray matter ribbon and extensive white matter edema.


Encephalopathy due to hypoxic-ischemic injury usually manifests within the first few hours after birth. A clinical history that includes a low Apgar score, need for resuscitation, decreased cord arterial pH level, other organ failure, respiratory failure, or some combination of these factors increases the level of confidence in a diagnosis of hypoxic-ischemic injury.

Neonates are able to tolerate short duration hypoxic-ischemic events. Prolonged hypoxia or hypoperfusion result in watershed injury; the intervascular zones between the anterior and middle cerebral arteries and the middle and posterior cerebral arteries represent the vulnerable zones in the term neonate. Autoregulation provides relative protection of the metabolically active tissues in the brain of the term neonate which are most susceptible to injury including the lateral thalami, posterior putamina, hippocampi, brainstem, corticospinal tracts, and the sensorimotor cortex.

On CT this is manifested by hypodensity, loss of junctional differentiation and/or petichial hemorrhage. On MR cytotoxic edema is demonstrated by increased T2 signal and restricted diffusion in the cortex and subcortical white matter. MR spectroscopy reveals increased lactate concentration.


Chao CP, Zaleski CG, Patton AC. Neonatal Hypoxic-Ischemic Encephalopathy: Multimodality Imaging Findings. Radiographics (2006); 26:S159-S172.

Shroff MM, Soares-Fernandes JP, Whyte H, Raybaud C. MR Imaging for Diagnostic Evaluation of Encephalopathy in the Newborn. Radiographics (2010); 30:763-780.

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