Evaluation of spectrum of MRI findings in children with Hypoxic Ischemic Encephalopathy and its comparison with transcranial sonography

Background: Hypoxic ischemic encephalopathy is a serious concern among asphyxiated newbornsdue to the associated long term sequelae like cognitive impairment and cerebral palsy. Though theincidence of hypoxic injury remains higher in preterm babies due to incomplete brain maturation, itcan occur in term babies as well despite institutional deliveries due to an array of unavoidable fetal,maternal and placental causes. Aims: This study was conducted as an attempt to evaluate the riskfactors, to study the correlation between the term of pregnancy with TCUS and MRI imaging findingsin HIE and characterise patterns of CNS involvement. Materials and methods: It was a cross-sectional study carried on 50 neonates with clinically diagnosed HIE presenting to the Department ofRadiodiagnosis, Rajindra Hospital Patiala who were subjected to transcranial sonography and MRI.Results and Conclusion: This study demonstrated term infants have significant involvement ofbasal ganglia thalamus type (central) pattern of involvement and preterm infants haveperiventricular leukomalacia type (white matter injury) of a pattern of involvement. The overallsensitivity and specificity of TCUS in detecting imaging findings in children with clinically diagnosedHIE compared to MRI was found to be 70.45% and 50% respectively, yielding the overall diagnosticaccuracy of TCUS as 68% compared to MRI. TCUS can depict central and white matter abnormalitiesbetter than peripheral lesions. However MRI provides additional diagnostic information in manycases and can detect precisely the extent of brain injury.

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Correlation Between White Matter Injury Identified by Neonatal Diffusion Tensor Imaging and Neurodevelopmental Outcomes Following Term Neonatal Asphyxia and Therapeutic Hypothermia: An Exploratory Pilot Study

Journal of Child Neurology ◽

10.1177/0883073819841717 ◽

2019 ◽

Vol 34 (10) ◽

pp. 556-566 ◽

Cited By ~ 4

Author(s):

Gwendolyn J. Gerner ◽

Eric I. Newman ◽

V. Joanna Burton ◽

Brenton Roman ◽

Elizabeth A. Cristofalo ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Pilot Study ◽

Therapeutic Hypothermia ◽

Diffusion Tensor ◽

White Matter Injury ◽

Hypoxic Ischemic Encephalopathy ◽

Group Differences ◽

Neurodevelopmental Outcomes ◽

Ischemic Encephalopathy

Aim: Hypoxic-ischemic encephalopathy is associated with damage to deep gray matter; however, white matter involvement has become recognized. This study explored differences between patients and clinical controls on diffusion tensor imaging, and relationships between diffusion tensor imaging and neurodevelopmental outcomes. Method: Diffusion tensor imaging was obtained for 31 neonates after hypoxic-ischemic encephalopathy treated with therapeutic hypothermia and 10 clinical controls. A subgroup of patients with hypoxic-ischemic encephalopathy (n = 14) had neurodevelopmental outcomes correlated with diffusion tensor imaging scalars. Results: Group differences in diffusion tensor imaging scalars were observed in the putamen, anterior and posterior centrum semiovale, and the splenium of the corpus callosum. Differences in these regions of interest were correlated with neurodevelopmental outcomes between ages 20 and 32 months. Conclusion: Therapeutic hypothermia may not be a complete intervention for hypoxic-ischemic encephalopathy, as neonatal white matter changes may continue to be evident, but further research is warranted. Patterns of white matter change on neonatal diffusion tensor imaging correlated with neurodevelopmental outcomes in this exploratory pilot study.

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Electroencephalogram abnormalities in full term infants with history of severe asphyxia

Paediatrica Indonesiana ◽

10.14238/pi55.6.2015.297-301 ◽

2016 ◽

Vol 55 (6) ◽

pp. 297

Author(s):

Susanti Halim ◽

I Gusti Nyoman Made Suwarba ◽

I Made Kardana

Keyword(s):

Cross Sectional Study ◽

Full Term ◽

Hypoxic Ischemic Encephalopathy ◽

Chi Square ◽

Term Infants ◽

Cross Sectional ◽

Term Neonates ◽

History Of ◽

Abnormal Eegs ◽

Ischemic Encephalopathy

ingtool used to determine developmental and electrical problemsin the brain. A history of severe asphyxia is a risk factor for thesebrain problems in infants.Objective To evaluate the prevalence of abnormal EEGs infull term neonates and to assess for an association with severeasphyxia, hypoxic ischemic encephalopathy (HIE), and spontaneousdelivery.Methods This cross-sectional study was conducted at thePediatric Outpatient Department of Sanglah Hospital, Denpasar,from November 2013 to January 2014. Subjects were fullterminfants aged 1 month who were delivered and/or hospitalized atSanglah Hospital. All subjects underwent EEG. The EEGs wereinterpreted by a pediatric neurology consultant, twice, with aweek interval between readings. Clinical data were obtainedfrom medical records. Association between abnormal ECG andsevere asphyxia were analyzed by Chi-square and multivariablelogistic analyses.Results Of 55 subjects, 27 had a history of severe asphyxia and 28were vigorous babies. Forty percent (22/55) of subjects had abnormalEEG findings, 19/22 of these subjects having history of severeasphyxia, 15/22 had history of hypoxic-ischemic encephalopathy(HIE), and 20/22 were delievered vaginally. There were strongcorrelations between the prevalence of abnormal EEG and historyof severe asphyxia, HIE, and spontaneous delivery.Conclusion Prevalence of abnormal EEG among full-term neonatesreferred to neurology/growth development clinic is around40%, with most of them having a history of severe asphyxia. AbnormalEEG is significantly associated to severe asphyxia, HIE, andspontaneous delivery.

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Diffusion tensor imaging assesses white matter injury in neonates with hypoxic-ischemic encephalopathy

Neural Regeneration Research ◽

10.4103/1673-5374.205102 ◽

2017 ◽

Vol 12 (4) ◽

pp. 603 ◽

Cited By ~ 5

Author(s):

Xing Feng ◽

Hong-xin Li ◽

Qian Wang ◽

Xuan Dong ◽

Min Yu ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Diffusion Tensor ◽

White Matter Injury ◽

Hypoxic Ischemic Encephalopathy ◽

Ischemic Encephalopathy

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Arterial Stiffness Is Associated with White Matter Disruption and Cognitive Impairment: A Community-Based Cohort Study

Journal of Alzheimer s Disease ◽

10.3233/jad-201424 ◽

2021 ◽

Vol 80 (2) ◽

pp. 567-576

Author(s):

Fei Han ◽

Fei-Fei Zhai ◽

Ming-Li Li ◽

Li-Xin Zhou ◽

Jun Ni ◽

...

Keyword(s):

Cognitive Function ◽

White Matter ◽

Arterial Stiffness ◽

Cognitive Decline ◽

Sex Education ◽

Diffusion Tensor ◽

Mean Diffusivity ◽

White Matter Injury ◽

White Matter Integrity ◽

Cross Sectional

Background: Mechanisms through which arterial stiffness impacts cognitive function are crucial for devising better strategies to prevent cognitive decline. Objective: To examine the associations of arterial stiffness with white matter integrity and cognition in community dwellings, and to investigate whether white matter injury was the intermediate of the associations between arterial stiffness and cognition. Methods: This study was a cross-sectional analysis on 952 subjects (aged 55.5±9.1 years) who underwent diffusion tensor imaging and measurement of brachial-ankle pulse wave velocity (baPWV). Both linear regression and tract-based spatial statistics were used to investigate the association between baPWV and white matter integrity. The association between baPWV and global cognitive function, measured as the mini-mental state examination (MMSE) was evaluated. Mediation analysis was performed to assess the influence of white matter integrity on the association of baPWV with MMSE. Results: Increased baPWV was significantly associated with lower mean global fractional anisotropy (β= –0.118, p < 0.001), higher mean diffusivity (β= 0.161, p < 0.001), axial diffusivity (β= 0.160, p < 0.001), and radial diffusivity (β= 0.147, p < 0.001) after adjustment of age, sex, and hypertension, which were measures having a direct effect on arterial stiffness and white matter integrity. After adjustment of age, sex, education, apolipoprotein E ɛ4, cardiovascular risk factors, and brain atrophy, we found an association of increased baPWV with worse performance on MMSE (β= –0.093, p = 0.011). White matter disruption partially mediated the effect of baPWV on MMSE. Conclusion: Arterial stiffness is associated with white matter disruption and cognitive decline. Reduced white matter integrity partially explained the effect of arterial stiffness on cognition.

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Temporal Trends in the Severity and Mortality of Neonatal Hypoxic-Ischemic Encephalopathy in the Era of Hypothermia

Neonatology ◽

10.1159/000518654 ◽

2021 ◽

pp. 1-8

Author(s):

Cristina Vega-Del-Val ◽

Juan Arnaez ◽

Sonia Caserío ◽

Elena Pilar Gutiérrez ◽

Marta Benito ◽

...

Keyword(s):

Temporal Trends ◽

Cross Sectional Study ◽

Annual Incidence ◽

Hypoxic Ischemic Encephalopathy ◽

Cross Sectional ◽

Incidence And Mortality ◽

Changes Over Time ◽

Ischemic Encephalopathy ◽

Annual Decline ◽

Over Time

Introduction: There is a paucity of studies examining temporal trends in the incidence and mortality of moderate-to-severe hypoxic-ischemic encephalopathy (HIE) during the last decade of therapeutic hypothermia (TH). Methods: Multicenter cross-sectional study of all infants ≥35 weeks gestational age diagnosed with moderate-to-severe HIE within 6 h of birth in an extensive region of Spain between 2011 and 2019, in order to detect trend changes over time in the (1) annual incidence, (2) severity of neurological and systemic organ involvement, and (3) neonatal death from HIE. Results: Annual incidence rate of moderate-to-severe HIE was 0.84 (95% confidence interval [CI] 0.7–0.97) per 1,000 births, without trend changes over time (p = 0.8), although the proportion of severe HIE infants showed an average annual decline of 0.86 points (95% CI 0.75–0.98). There were 102 (70%) infants diagnosed with moderate HIE and 44 (30%) with severe HIE. TH was offered to 139/146 (95%) infants. Infants with clinical and/or electrical seizures showed a decreasing trend from 56 to 28% (p = 0.006). Mortality showed a nonstatistically significant decline (p = 0.4), and the severity of systemic damage showed no changes (p = 0.3). Obstetric characteristics remained unchanged, while higher perinatal pH values (p = 0.03) and Apgar scores (p = 0.05), and less need for resuscitation (p = 0.07), were found over time. Conclusion: The annual incidence of moderate-to-severe HIE has stabilized at around 1 per 1,000 births, with a temporal trend toward a decrease in severe HIE infants and a slight decline of mortality. No association was found between temporal trends and changes in perinatal/obstetric characteristics over time.

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Infection and white matter injury in infants with congenital cardiac disease

Cardiology in the Young ◽

10.1017/s1047951111000473 ◽

2011 ◽

Vol 21 (5) ◽

pp. 562-571 ◽

Cited By ~ 9

Author(s):

Hannah C. Glass ◽

Chelsea Bowman ◽

Vann Chau ◽

Alisha Moosa ◽

Adam L. Hersh ◽

...

Keyword(s):

Risk Factors ◽

White Matter ◽

Bloodstream Infection ◽

Cardiac Disease ◽

Brain Injuries ◽

White Matter Injury ◽

Term Infants ◽

Established Risk Factor ◽

Congenital Cardiac Disease

AbstractMore than 60% of newborns with severe congenital cardiac disease develop perioperative brain injuries. Known risk factors include: pre-operative hypoxemia, cardiopulmonary bypass characteristics, and post-operative hypotension. Infection is an established risk factor for white matter injury in premature newborns. In this study, we examined term infants with congenital cardiac disease requiring surgical repair to determine whether infection is associated with white matter injury. Acquired infection was specified by site – bloodstream, pneumonia, or surgical site infection – according to strict definitions. Infection was present in 23 of 127 infants. Pre- and post-operative imaging was evaluated for acquired injury by a paediatric neuroradiologist. Overall, there was no difference in newly acquired post-operative white matter injury in infants with infection (30%), compared to those without (31%). When stratified by anatomy, infants with transposition of the great arteries, and bloodstream infection had an estimated doubling of risk of white matter injury that was not significant, whereas those with single ventricle anatomy had no apparent added risk. When considering only infants without stroke, the estimated association was higher, and became significant after adjusting for duration of inotrope therapy. In this study, nosocomial infection was not associated with white matter injury. Nonetheless, when controlling for risk factors, there was an association between bloodstream infection and white matter injury in selected sub-populations. Infection prevention may have the potential to mitigate long-term neurologic impairment as a consequence of white matter injury, which underscores the importance of attention to infection control for these patients.

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Protective Effects ofN-Acetyl-L-Cysteine in Human Oligodendrocyte Progenitor Cells and Restoration of Motor Function in Neonatal Rats with Hypoxic-Ischemic Encephalopathy

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2015/764251 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Dongsun Park ◽

Kyungha Shin ◽

Ehn-Kyoung Choi ◽

Youngjin Choi ◽

Ja-Young Jang ◽

...

Keyword(s):

White Matter ◽

Progenitor Cells ◽

Hypoxic Ischemic Encephalopathy ◽

Oligodendrocyte Progenitor Cells ◽

Protective Effects ◽

Neonatal Rats ◽

Motor Functions ◽

Ischemic Encephalopathy

Objective. Since oligodendrocyte progenitor cells (OPCs) are the target cells of neonatal hypoxic-ischemic encephalopathy (HIE), the present study was aimed at investigating the protective effects ofN-acetyl-L-cysteine (NAC), a well-known antioxidant and precursor of glutathione, in OPCs as well as in neonatal rats.Methods. Inin vitrostudy, protective effects of NAC on KCN cytotoxicity in F3.Olig2 OPCs were investigated via MTT assay and apoptotic signal analysis. Inin vivostudy, NAC was administered to rats with HIE induced by hypoxia-ischemia surgery at postnatal day 7, and their motor functions and white matter demyelination were analyzed.Results. NAC decreased KCN cytotoxicity in F3.Olig2 cells and especially suppressed apoptosis by regulating Bcl2 and p-ERK. Administration of NAC recovered motor functions such as the using ratio of forelimb contralateral to the injured brain, locomotor activity, and rotarod performance of neonatal HIE animals. It was also confirmed that NAC attenuated demyelination in the corpus callosum, a white matter region vulnerable to HIE.Conclusion. The results indicate that NAC exerts neuroprotective effectsin vitroandin vivoby preserving OPCs, via regulation of antiapoptotic signaling, and that F3.Olig2 human OPCs could be a good tool for screening of candidates for demyelinating diseases.

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