Remote changes in the midbrain after hypoxic encephalopathy

Abstract

An 11-month-old boy developed fever associated with influenza B infection, followed two days later by sudden cardiopulmonary arrest due to unknown etiology. Resuscitation was successfully performed and he was transferred to our hospital. After admission, intensive treatment was performed and he gradually recovered, however, he was left with severe neurological sequelae, such as spastic quadriplegia and severe mental retardation. Serial magnetic resonance imagings (MRI) during the course of illness are shown in Figs 1 and 2. Three days after admission, diffusion-weighted MRI disclosed lesions in the white matter areas of the bilateral centro-parietal and occipital lobes as well as putamen and claustrum with reduced diffusion (Fig. 1). Nine days after admission, diffusion-weighted MRI revealed lesions in the bilateral cerebral peduncles and globus pallidi with reduced diffusion (Fig. 2). These MRI findings may reflect serial changes of brain damage due to hypoxic encephalopathy. PeriRolandic and occipital regions are usually spared in children with hypoxic encephalopathy, and it remains unknown why this case showed peculiar distribution of the lesion in the initial phase. The lesion in the