0:00

Okay, so term brain imaging, uh,

0:03

there are multiple patterns described.

0:04

So it it depends on the duration, severity of the imaging.

0:08

So you might have just like a few little, you know,

0:11

embolic things or whatever, writes a little punt injury.

0:14

But the two most common are the

0:15

watershed and the central patterns.

0:17

So watershed is just like adults, right?

0:18

It's between like A-C-A-M-C, A PCA

0:21

or the internal, like the recurrent artery of hubner

0:23

and the, you know, lenticular, trites and whatnot.

0:26

Um, posterior choroidal.

0:27

So, um, so those are like more border zone,

0:30

mostly white matter, uh, kind of pattern.

0:33

And that's what you see with your partial asphyxia, right?

0:37

So like, not total, but like partial, like usually shorter,

0:41

but could be prolonged, but still, like they,

0:42

they had some oxygen but it was reduced, right?

0:45

And the central pattern, that's when you

0:47

have like severe, right?

0:48

So, so if you have like a complete anoxia,

0:51

severe prolonged, right?

0:52

Then now the most metabolically active structures

0:54

that are selectively vulnerable, right?

0:56

The basal ganglion thalami,

0:58

the corticospinal tracts, the hippo camp, right?

1:00

Those, the, the ones that require the most oxygen

1:03

and blood flow are gonna be selectively hit

1:05

because you have a complete anoxic situation.

1:08

Uh, there's also infant editorial injury,

1:09

which is usually underestimated

1:11

and that's typically seen with advanced cases.

1:12

And then you could have just diffuse or global injury. Okay?

1:16

So timing wise, right?

1:18

Uh, just like in adult stroke, right, the diffusion

1:21

will peak, you know, usually like two to three days after,

1:24

but it, you know, anywhere from one to four

1:26

as you get toward a week, right?

1:28

You start to have pseudo normalization

1:30

because the restricted diffusion in the swollen dying cell

1:33

membranes, the cell membranes license,

1:35

they release the edema into the, you know, uh,

1:37

interstitial space.

1:38

And so you get that, uh, pseudo normalization of the A DC.

1:41

So then after that you can't really use this.

1:44

So you can use the other things like I mentioned, the T one

1:46

that dys myelination, um, on the watery brain background

1:49

that T one hyperintensity is helpful.

1:52

Often edema on top

1:53

of an already watery brain is hard to appreciate.

1:56

So it's pretty hard in many cases to see the T two

1:59

unless it's in a myelinate area like the clicks.

2:02

So that's usually more helpful late when you start

2:04

to see like the ence laia or the gliosis or whatever.

2:07

So it starts to present, uh, more in the late period.

2:10

Uh, but you can see it's very dependent on

2:12

kind of physiology and timing.

2:13

And then you can also do perfusion to look

2:15

that hyperperfusion response and metabolism.