Cystic Neuronal Necrosis of Posterior Thalami in Neonatal Hypoxic Ischemic Encephalopathy: A Case Report of an Unusual Radiological Finding

Abstract

Background: Neonatal hypoxic ischemic encephalopathy (HIE) occurs as a result of any event that causes hypoxia and hypoperfusion to the developing neonatal brain. In addition to being a major cause of neonatal mortality, it is also associated with significant long-term neurological deficits. Multicystic encephalomalacia is a sequelae to global hypoxic ischemic injury which is characterized by cortical atrophy, basal ganglia/thalamic atrophy, and cystic necrosis of cerebral white matter. In this report, we present an unusual finding of cystic necrosis of thalami in HIE. Case Presentation: We present the case of a term neonate with a history of prolonged labor and meconium aspiration who developed HIE stage III. The neonate initially required ventilator support and was gradually weaned off but was reintubated in view of neonatal sepsis. Magnetic resonance imaging done on day 23 revealed diffuse cortical and white matter atrophy, signal intensity alteration in basal ganglia and thalami, and multiple well-defined areas of cerebrospinal fluid signal intensity in the white matter, consistent with multicystic encephalomalacia. An additional unusual finding was cystic necrosis, symmetrically involving bilateral posterior thalami. Conclusion: According to our observation, severe prolonged hypoxic ischemic insult does not only result in central gray matter atrophy but can also cause cystic neuronal necrosis of the same.