MRI brain in a neonate with a history of perinatal asphyxia shows selective injury to the thalami and posterior putamen bilaterally, with involvement of the perirolandic cortex. This pattern of selective injury reflects vulnerability of which metabolic parameter during acute profound hypoxia-ischaemia?
- A Venous drainage pattern preferentially affecting thalami
- B Highest metabolic activity (glucose and oxygen utilisation) in myelinating and somatosensory areas at term ✓
- C Arterial watershed zone distribution
- D Preferential involvement of periventricular white matter (PWML) in term neonates
Correct answer: B. Highest metabolic activity (glucose and oxygen utilisation) in myelinating and somatosensory areas at term
Explanation
In acute profound hypoxia-ischaemia at term, the pattern of injury reflects regions with the highest metabolic rate at term — the deep grey nuclei (thalami, posterior putamen) and perirolandic cortex are most active in synaptic activity and myelination, making them most vulnerable. This is the 'central' or 'deep' pattern of HIE. Watershed/parasagittal injury occurs in partial prolonged asphyxia. Periventricular leukomalacia (PVL) is the predominant pattern in preterm neonates.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.