Brain MRI findings in newborn infants with initial severely abnormal aEEG pattern
| MRI evidence for brain injury* | |||||
|---|---|---|---|---|---|
| Patient | Basal ganglia | Watershed | Other | ||
| Patient 5 | |||||
| DOL 1 not available | – | – | – | ||
| DOL 3 (54.0 h of life / 47.4 h after starting hypothermia) | BG 0 | W 2 | Subtle areas of T2 prolongation within bilateral parieto-occipital and frontal white matter, present on all scans without showing any evolution. No evidence of abnormal diffusion. Normal MRS studies. | Cephalohaematoma on DOL 3, resolved on DOL 8. | |
| DOL 8 | BG 0 | W 2 | |||
| 1 month of age not available | – | – | – | ||
| Patient 6 | |||||
| DOL 1 (24.0 h of life /20.1 h after starting hypothermia) | BG 0 | W 0 | Periventricular punctate foci of T1 hyperintensity on DOL 1 and DOL 2, resolving on DOL 10, most compatible with petechial haemorrhages. Cephalohaematoma stable on DOL 1 and DOL 2, resolved on DOL 10. | ||
| DOL 2 (48.0 h of life / 44.1 h after starting hypothermia) | BG 0 | W 0 | |||
| DOL 10 | BG 0 | W 0 | |||
| 1 month of age (DOL 31) | BG 0 | W 0 | |||
| Patient 7 | |||||
| DOL 1 not available | – | – | – | ||
| DOL 2 (34.0 h of life / 31.4h after starting hypothermia) | BG 0 | W 2 | Subtle areas of T2 prolongation within bilateral parieto-occipital and frontal white matter, present on all scans without showing any evolution. No evidence of abnormal diffusion. Normal MRS studies. | ||
| DOL 10 | BG 0 | W 2 | |||
| 1 month of age not available | – | – | – | ||
| Patient 8 | |||||
| DOL 1 (15.0 h of life / 11.7 h after starting hypothermia) | BG 0 | W 0 | Non-occlusive dural venous sinus thrombosis involving bilateral transverse and superior sagittal sinuses, decreased on DOL 2 compared to DOL 1 and resolved on DOL 11. No MR evidence for venous infarction. | ||
| DOL 2 (41.0 h of life / hypothermia stopped) | BG 0 | W 0 | |||
| DOL 11 | BG 0 | W 0 | |||
| 1 month of age (DOL 31) | BG 0 | W 0 | Cephalohaematoma stable on DOL 1 and DOL 2, resolved on DOL 11. | ||
| Patient 9 | |||||
| DOL 1 (7.0 h of life/ 1.4 h after starting hypothermia) | BG 0 | Questionable restricted diffusion and T2 signal abnormality within corticospinal tracts. Questionable lactate doublet on spectroscopy. | W 0 | Cephalohaematoma stable on DOL 1 and DOL 2, resolved on DOL 10. | |
| DOL 2 (29.5 h of life/ 23.9 h after starting hypothermia) | BG 4 | Restricted diffusion on DOL 2 and T1/T2 signal abnormality on DOL 2, DOL 10 and at 1 month within bilateral thalami, subthalamic nuclei and corticospinal tracts. Lactate doublet on DOL 2 and DOL 10. | W 0 | ||
| DOL 10 | BG 4 | W 0 | |||
| 1 month of age (DOL 32) | BG 4 | W 0 | |||
| Patient 10 | |||||
| DOL 1 (11.0 h of life / 8.1 h after starting hypothermia) | BG 0 | W 0 | Moderate subgaleal haematoma on DOL 1 and DOL 2. | ||
| DOL 2 (41.0 h of life/ 38.1 h after starting hypothermia) | BG 4 | Restricted diffusion within bilateral perirolandic white matter, thalami and corticospinal tracts. Equivocal restricted diffusion within vermis. Lactate doublet on spectroscopy. | W 0 | ||
| DOL 10 not available | – | – | – | ||
| 1 month of age not available | – | – | – | ||
| Patient 11 | |||||
| DOL 1 (8.5 h of life/ 3.3 h after starting hypothermia) | BG 0 | No evidence of restricted diffusion. Questionable lactate doublet on spectroscopy. | W 0 | Small focus of susceptibility within right peritrigonal centrum semiovale, likely representing thrombus within a medullary vein. New minimal lateral ventricular haemorrhage on DOL 2, likely secondary to medullary vein thrombosis. | |
| DOL 2 (35.5 h of life/29.7 h after starting hypothermia) | BG 4 | Restricted diffusion and T1/T2 signal abnormality within bilateral thalami and corticospinal tracts. Lactate doublet on spectroscopy. | W 0 | Small caput succedaneum on DOL 1 and DOL 2. | |
| DOL 10 not available | – | – | – | ||
| 1 month of age not available | – | – | – | ||
| Patient 12 | |||||
| DOL 1 (6.5 h of life/ 2.1 h after starting hypothermia) | BG 0 | W 2 | Multiple subcortical and a few periventricular foci of restricted diffusion compatible with microinfarcts, within bilateral frontal lobes and parietal lobes. | Minimal lateral ventricular haemorrhage bilaterally stable on DOL 1 and DOL 2. | |
| Cephalohaematoma stable on DOL 1 and DOL 2. | |||||
| DOL 2 (26.0 h of life/ 21.6 h after starting hypothermia) | BG 4 | Restricted diffusion within bilateral thalami, globus pallidus and corticospinal tracts. Restricted diffusion within cerebellar white matter. Lactate doublet on spectroscopy. | W 5 | Multifocal extended infarcts within both cerebral hemispheres involving the subcortical, periventricular and deep white matter in bilateral frontal, temporal and parietal lobes. | Very small subdural haematomas stable on DOL 1 and DOL 2. |
| DOL 10 not available | – | – | – | ||
| 1 month of age not available | – | – | – | ||
↵* Each MRI was categorised according to a scoring system described by Barkovich et al21 in a basal ganglia (BG) injury scale and a watershed (W) pattern injury scale. DOL, day of life; MRS, magnetic resonance spectroscopy.