Wk 5, Case 8 - Review

EXAM:

MRI Brain with and without intravenous contrast

INDICATION:

Newborn preterm (33 weeks) male with hypoxic ischemic encephalopathy. Evaluate for extent of injury and evaluate for arteriovenous malformation.

TECHNIQUE:

Multiplanar multisequence magnetic resonance imaging of the brain was performed with and without intravenous contrast on a 1.5 Tesla magnet and with injection of 0.15 cc Gadavist.

COMPARISON:

Ultrasound brain 9/5/2020

FINDINGS:

Diffusely elevated DWI signal with decreased ADC values (diffusion restriction) involving the near entirety of the cerebrum (with associated loss of gray-white matter differentiation), midbrain, dorsal pons, and dentate nuclei. Abnormal T2 signal within the near entirety of the brainstem reflective of edema.

No acute intracranial hemorrhage or extra-axial fluid collection.

No mass, mass effect, or midline shift. No abnormal areas of enhancement. No abnormal susceptibility artifact to suggest hemorrhage.

ASL perfusion imaging demonstrates symmetric decreased cerebral blood flow primarily within the MCA territories.

Ventricular size within normal limits for patient age. Major intracranial flow voids intact.

The paranasal sinuses are underpneumatized. Large bilateral mastoid effusions. Orbits normal. Scalp and calvarium unremarkable.

Partially visualized cervical spine appears unremarkable.

IMPRESSION:

Severe hypoxic ischemic encephalopathy with acute infarction of the near entire cerebrum, as well as infarcts of portions of the brainstem and the dentate nuclei of the cerebellum.