MR Imaging of Brain in a Paediatric with Hypoxic Ischemic Encephalopathy, a Retrospective Study in Tertiary Care Center

Abstract

Background: Hypoxic–ischemic encephalopathy (HIE) remains a major cause of morbidity and long-term neurodevelopmental impairment in children. While basal ganglia and cortical injuries are well described, white matter involvement represents a critical but variable manifestation of hypoxic–ischemic injury, particularly beyond the neonatal period. Magnetic resonance imaging (MRI) plays a pivotal role in detecting and characterizing these white matter changes and in understanding injury patterns related to hypoxia–ischemia.

Methods: This retrospective study included children under 18 years of age diagnosed with hypoxic–ischemic encephalopathy who underwent brain MRI at a tertiary care center over a defined study period. Conventional MRI sequences including T1-weighted, T2-weighted, FLAIR, and diffusion-weighted imaging were reviewed. White matter involvement was assessed for distribution, symmetry, extent, and predominant regions affected, including periventricular, subcortical, and deep white matter. Imaging findings were analysed descriptively and correlated with age at insult and clinical history.

Results: White matter abnormalities were identified in the majority of cases, with periventricular and subcortical white matter being the most frequently involved regions. Diffuse bilateral involvement was more common than focal changes. Younger children demonstrated a higher prevalence of periventricular white matter injury, while older children showed more extensive subcortical and deep white matter involvement. Associated cortical and deep gray matter abnormalities were observed in a subset of patients.

Conclusion: MRI demonstrates a broad spectrum of white matter changes in Paediatric hypoxic–ischemic encephalopathy, with patterns varying according to age and severity of insult. Recognition of these imaging patterns is essential for accurate diagnosis, prognostication, and clinical management. White matter assessment should be an integral component of MRI evaluation in children with suspected hypoxic–ischemic brain injury.