59 MRI FOLLOWING SEVERE PERINATAL ASPHYXIA

Abstract

In 42 children suffering from severe perinatal asphyxia we attempted to find early prognostic signs of severe hypoxicischemic brain injury with MRI. We performed 14 early (first week), 24 intermediate (second to fourth week) and 55 late MRI (after one month) procedures on a 2.35 MR-system. Severe cerebral necrosis could be suspected by T2 hyperintensity of the white matter, with blurred limits to the cortex in early MRI, and was confirmed by T1 hyperintensity of the cortex in intermediate MRI. Severe cerebral necrosis was established at 3 months. 9 of 10 children with this pattern showed severe cerebral palsy on follow-up. 24 children had normal late MRI or findings of uncertain pathological value. 9 children had a normal late MRI. In 8 children we could detect irregular myelination (patchy hyperintensities), which in some cases proved to be transient. In 5 children liquorspaces were enlarged, suggesting minimal atrophy. In two children late MRI were refused. Of these 24 children none developed severe cerebral palsy or marked mental retardation. Two children showed focal ischemic lesions, six had intracranial hemorrhages. The children did not differ in the severity of their perinatal history and findings, suggesting that MRI in the first 3 months is of significant prognostic value.Supported by Swiss National Foundation 32-954388,and 3824-0.87