Neuroradiology Department, Hospital Dona Estefânia e Hospital São José, Centro Hospitalar Universitário de Lisboa Central – CHULC
- XXXI Congresso SILAN, 24 a 27 Setembro 2019, Porto
Purpose: Hypoxic-ischemic injury (HII) to the brain is a significant cause of mortality and severe neurologic disability, with factors such as brain maturity, duration and severity of injury, type and timing of imaging studies all influencing factors. White matter lesions without overt damage to the central gray matter is less common and considered atypical.
Materials and Methods: We present three selected cases from our Department’s Neuroradiology database, with illustrative CT and mainly MRI imaging showing preferential white matter lesions in HII, considered to be atypical presentations in postnatal period and young infants.
Results. The following cases are presented: young female infant (2 years old) presenting with aspiration pneumonia and respiratory failure, 5-year-old infant who presented in the ER with ARDS due to H. influenzae pneumonia followed by cardiac arrest and lastly a 17-month infant with diagnosis of Rhombencephalitis due to Enterovirus 17 with respiratory failure. All of them ultimately developed HII, with restricted diffusion in subcortical areas of the brain not sparing U fibers as well, rather than the typical gray matter involvement.
Conclusion: Global ischemia will sometimes lead to demyelination and destruction of cerebral white matter, as DWI and ADC mapping are helpful in recognizing this condition by depicting areas with restricted diffusion. The white matter, in unusual cases, may be affected after ischemia without prominent grey matter involvement, so the recognition and awareness of these variations in HII is pivotal in its diagnosis.
Palavras Chave: Hypoxic-ischemic injury; White matter; inverse pattern; MRI; pediatric