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Joseph Junewick, MD FACR
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Term Ischemia

Case Detail

Joseph Junewick, MD FACR
Diagnostic Category: Vascular
Created: over 11 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: MR
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Term infant requiring rescusitation now with truncal hypotonia and extremity hypertonia.

Case Images


Deep hypoxic-ischemic injury.

Clinical Notes

Normal EEG.


MRS – Voxels in both right and left thalami demonstrate elevated choline peaks and lactate doublets in bilaterally.


The lateral thalami, posterior putamina, hippocampi, brainstem, corticospinal tracts and sensorimotor cortex are metabolically active and consequently vulnerable to hypoxia, hypoglycemia and hypotension.

Severe hypotension leads to acidosis. Increased levels of inflammatory mediators, excitatory neurotransmitters, free radicals and calcium result. Loss of autoregulation and consumption of intracellular energy lead to neuronal injury and eventual cell death.

MR spectroscopy signature of ischemic injury is increased choline and decreased NAA relative to the creatine standard and the appearance of lactate; the magnitude of the lactate peak is correlated with poor neurocognitive outcome.


Chao CP, Zaliski CG and Patton AC. Neonatal hypoxic-ischemic encephalopathy: Multimodality imaging findings. Radiographics (2005); 26:S159-S172.

Barkovich AJ, et al. Proton MR spectroscopy for the evaluation of brain injury in asphyxiated term neonates. AJNR (1999); 20:1399-1405.

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