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UVC Related Hepatic Injury
Joseph Junewick, MD FACR
over 9 years ago
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Case History

Term infant requiring rescusitation now with truncal hypotonia and extremity hypertonia.

Case Detail

Joseph Junewick, MD FACR
Diagnostic Category: Vascular
Created: over 9 years ago
Updated: over 8 years ago
Tags: PEDS
Modality/Study Types: MR
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Reveal Clinical Notes

Normal EEG.

Reveal Findings

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

Reveal Discussion

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.

Reveal Diagnosis

Deep hypoxic-ischemic injury.

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