Imaging the term neonatal brain Flashcards

1
Q

What is neonatal encephalopathy?

A

clinically defined syndrome of disturbed neurological function in the earliest day of life in the term infant

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2
Q

Patterns of injury in HIE?

A
  1. Watershed
    * affects areas between brain’s major arterial supplies deep in sulci
    * best seen DOL 3-5 as restricted diffusion on DWI
    * Maximal injury day 10-14 on T1 and T2 images
    * Predicts language outcomes
  2. Basal ganglia/thalamic
    * in acute, profound hypoxia-ischemia
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3
Q

Most common area for neonatal stroke?

How does it present?

A

L MCA
Usually presents with seizures
MRI is most sensitive

Note: more common in neonatal period than any other time in childhood

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4
Q

When should CT be done as first line in the term neonatal brain?

A
  • urgent situations when MRI not available
  • infant too unstable for MRI
  • trauma or skull fracture suspected
  • If done, ideally within 72 +/- 12 hours of suspected insult. Subsequent MRI recommended.
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5
Q

What is the best imaging modality for IEM in neonates?

A
  • MRI is optimal modality

* DWI and MRSI helpful for MSUD, nonketotic hyperglycinemia, creatinine deficiency

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6
Q

What is the best head imaging modality for congenital infection in neonates?

A
  • MRI preferred but may miss calcifications evident on CT

* MRI for all infants with symptomatic congenital CMV and infants with abnormal US

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7
Q

What is the preferred imaging technique in neonates with bilirubin encephalopathy?

A

MRI

DO NOT do MRI in neonates with severe hyperbili in absence of encephalopathy

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8
Q

What does a normal MRI in HIE suggest?

A

likelihood of severe neurodevelopmental impariment is low

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9
Q

What imaging modalities are used for neonatal traumatic brain injury?

A
  • MRI - modality of choice for parenchymal injury

* CT- modality of choice in trauma (detection of bone fracture is priorty)

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10
Q

What is the best imaging modality for cerebral dysgenesis/structural abnormality?

A

MRI

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11
Q

What imaging is done for HIE that is cooled?

A
  • MRI DOL 3-5 or after rewarming
  • repeat at 10-14 DOL when imaging and clinical features discordant or when diagnostic ambiguity persists
  • consistent timing important to facilitate recognition of injury patterns on specific sequences
  • Important for diagnosis, counselling about infant’s prognosis and potential outcomes, and for guiding decisions about care
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