Günay RONA, Meral ARİFOĞLU, Hediye Pınar GÜNBEY, Ufuk YÜKSELMİŞ

Restricted diffusion of the corpus callosum in extensive neonatal hypoxic–ischemic encephalopathy

Hypoxic-ischemic encephalopathy (HIE) is a devastating brain injury that may result in death and severe neurologic deficits. Corpus callosum (CC) involvement, especially its entire involvement, is very rare in HIE. A 41-week-old male term neonate had a difficult delivery and developed cardiac arrest after birth. His Apgar scores were low in the first 10 minutes. The magnetic resonance imaging (MRI) showed high signal intensity in bilateral basal ganglia, bilateral thalami, temporofrontal cortex, subcortical white matter, perirolandic region, and the entire corpus callosum in T1 sequences. Restricted diffusion was noted on the diffusion-weighted imaging (DWI) images of all these regions. CC is affected in cases of severe and advanced brain injury, and especially splenial lesions have poor outcomes. Entire CC involvement may lead to worse clinical presentation and can serve as an early neuroradiologic marker.

PDF

___

1. Barkovich AJ. Brain and spine injuries in infancy and childhood. In: Barkovich AJ, ed. Pediatric neuroimaging. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005;190-290.

2. Ashwal S, Majcher JS, Vain N, et al. Patterns of fetal lamb regional cerebral blood flow during and after prolonged hypoxia. Pediatr Res. 1980;14:1104- 10.

3. Takanashi J, Barkovich AJ, Shiihara T, et al. Widening spectrum of a reversible splenial lesion with transiently reduced diffusion. AJNR Am J Neuroradiol. 2006;27:836-8.

4. Volpe J. Neurology of the Newborn. 5th ed. Philadelphia: Saunders; 2008 5. Kale A, Joshi P, Kelkar AB. Restricted diffusion in the corpus callosum: A neuroradiological marker in hypoxic-ischemic encephalopathy. Indian J Radiol Imaging. 2016;26:487-92.

6. Nagy Z, Lindström K, Westerberg H, et al. Diffusion tensor imaging on teenagers, born at term with moderate hypoxic-ischemic encephalopathy. Pediatr Res. 2005;58:936-40.

7. Takenouchi T, Heier LA, Engel M, et al. Restricted diffusion in the corpus callosum in hypoxic-ischemic encephalopathy. Pediatr Neurol. 2010;43:190-6.

8. Forbes KP, Pipe JG, Bird R. Neonatal hypoxic-ischemic encephalopathy: detection with diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 2000;21:1490-6.

9. Huang BY, Castillo M. Hypoxic-ischemic brain injury: imaging findings from birth to adulthood. Radiographics. 2008;28:417-617.

10. Robertson RL, Ben-Sira L, Barnes PD, et al. MR line-scan diffusionweighted imaging of term neonates with perinatal brain ischemia. AJNR Am J Neuroradiol. 1999;20:1658-70.

11. Heinz ER, Provenzale JM. Imaging findings in neonatal hypoxia: a practical review. AJR Am J Roentgenol. 2009;192:41-7.