A neonate presents with seizures on day 3 of life. MRI brain shows bilateral symmetrical signal abnormality involving the posterior limb of the internal capsule, ventrolateral thalami, basal ganglia, and perirolandic cortex on DWI and T1-weighted sequences with corresponding restricted diffusion. What pattern of injury does this represent and what is the most common underlying cause?
- A Peripheral watershed pattern due to partial prolonged hypoxia
- B Central pattern of hypoxic-ischaemic injury due to profound acute asphyxia ✓
- C Periventricular leukomalacia due to prematurity
- D Herpes simplex encephalitis involving limbic structures
Explanation
Neonatal hypoxic-ischaemic encephalopathy (HIE) produces two distinct injury patterns depending on duration and severity of insult. Profound acute asphyxia (sudden severe oxygen deprivation) damages the most metabolically active regions: the posterior limb of the internal capsule, ventrolateral thalami, basal ganglia, and perirolandic cortex — the central or deep nuclear pattern. Partial prolonged hypoxia produces the peripheral watershed pattern involving parasagittal cortex and white matter. The central pattern carries a worse prognosis for motor outcomes. MRI with DWI in the first week, ideally after 24-48 hours, is the most sensitive imaging modality.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.