Hypoxic-ischemic Brain Lesions Research Articles

Brain anatomopathological findings in neonates with congenital heart disease.

Neonates with congenital heart disease can develop neurological problems, which is why it is important to know the time and extent at which these lesions occur in order to elucidate their causes and implications. To describe brain morphological alterations in autopsies of neonates with congenital heart disease. The cases of neonates with congenital heart disease and complete autopsy registered in the pathology department from 2009 to 2019 were included. Descriptive statistics were used with the calculation of frequencies and percentages. Of a total of 21 patients, 61.9% were full-term males; median weight and age at admission were 2500 g and five days, respectively; mean hospital stay was seven days. The predominant heart disease was aortic arch pathology. Fifteen patients (71.3%) underwent surgery; 50% died of cardiogenic shock, 100% had hypoxic-ischemic brain lesions, 71% had incipient lesions, and 33.3%, parenchymal hemorrhage. There are various risk factors for neurological damage in patients with complex congenital heart disease, which is impossible to be entirely controlled. This study allows us to know, for the first time in our milieu, the changes in the central nervous system that could exist in these patients.

Магнитно-резонансная томография при гипоксически-ишемических поражениях мозга у новорожденных: эволюция взглядов и перспективы развития

Aim: Based on the study of a large amount of available information, to create an idea of the use of magnetic resonance imaging (MRI) in hypoxic-ischemic brain lesions in newborns, to present the available research algorithms, classifications, the scope of the technique and its information content in the named pathology. Key points. MRI has long been a common practice in a neuropediatric hospital. To date, examination by this method has absolute significance in the diagnosis of perinatal hypoxic-ischemic brain lesions. In addition, MRI data help to objectify the effectiveness of therapeutic interventions and predict the further development of a child with perinatal brain damage. There are several classifications of MRI changes in hypoxic-ischemic brain lesions in newborns. These classifications have varying degrees of sensitivity to the initial hypoxic-ischemic changes in the child's brain, however, allow us to roughly represent the process of their formation in dynamics in the morphological aspect according to the scheme “periventricular white matter — subcortical ganglia and thalamus — subcortical structures of the hemispheres and cerebral cortex”. Thus, the target structures of hypoxic ischemic lesions allow us to identify its main patterns: lesions of neuronal structures, leukopathy, and their combination. Conclusion. Studies of MRI phenomena as predictors of developmental pathology show that an increase in detail increases the accuracy of the prognosis. However, the available data do not currently allow us to form a spatial model for the development of hypoxic-ischemic changes in the brain of a newborn. It seems necessary to create such a model depending on the time and intensity of the impact of the ischemic process. This will allow developing a morphological and pathophysiological classification of perinatal encephalopathies. Keywords: magnetic resonance imaging, hypoxia-ischemia, hypoxic-ischemic brain damage, newborns, cerebral palsy.

Structural changes of brain vessels in cardiosurgery patients with postoperative stroke

Hypoxic-ischemic lesions of the brain of cardiac surgery patients as a leading factor in stroke have been studied. The importance of prolonged thrombosis, embolism, which exacerbate the general degenerative changes in the central nervous system is recognized.
 The aim of the research – to study the morphological changes of the vessels of the brain of cardiac surgery patients with postoperative stroke on the background of hypoxic-ischemic complications.
 Materials and methods. Pieces of cerebral vessels were subjected to microscopic examination. Histological sections were stained according to Van Gieson.
 Results and their discussion. The study of the structure of the vessels of the brain of persons who were in the group intact to neurological pathology control, showed the presence of anatomical and functional changes that are fully consistent with the sex-age norms of postnatal human ontogenesis.
 The drugs of the clinical observation group contained signs of pathological changes characteristic of hypoxic-ischemic disorders. It is obvious that their appearance and intensification contributed to the development of ischemic stroke. Structural and functional changes mainly concerned the vascular walls, their layers, paravasal spaces, the blood system as a liquid phase, in fact. Endothelial layer with signs of desquamation. Endothelial cells are characterized by signs of hyperchromia of the nuclei, the shift of the latter in the direction of one of the poles of the cells, the appearance of heterochromatin. Contacts between cells are weakened, defects are visible in the surface layer. Perovascular edema, which is formed in the case of increased permeability, leads to a certain isolation of individual vessels from the surrounding tissues, followed by the development of hypoxia. Defects of the wall layers lead to the activation of the migratory properties of platelets, encourage the appearance of megakaryocytes, erythrocyte thrombi, which are in close contact with the endothelial layer of blood vessels. On histological specimens, brick-red blood clots abundantly cover the damaged inner layer of vascular walls, sometimes completely filling their openings. Over time, defects in the layers of the walls are accompanied by thrombosis, inflammation, edema.
 Conclusions. Hypoxic-ischemic brain lesions in cardiac surgery patients play a leading role in stroke. Priority is given to hypoxia, which contributes to ischemia, trophic disorders, atrophy, necrosis, necrobiotic changes. The latter are the organic basis of pathogenetic patterns of focal cerebral infarction (with progressive destruction of brain cells, its vessels, the development of prolonged thrombosis, embolism, increased general degenerative changes in the central nervous system)

Hypoxic-ischemic brain injuries in cardiosurgical patients (rationale of causal connections)

Summary. The presented article substantiates the materials on causation in the most common variants of hypoxic-ischemic brain lesions in cardiac surgery patients. The study showed that the functional changes assumed by the patient's brain (under the conditions of heart surgery using the resources of artificial circulation), reflects the state of the structural patterns of the whole organism. The aim of the study – to analyze the clinical and anamnestic materials on pathogenetic prototypes of hypoxic-ischemic lesions that occur in patients as a result of cardiac surgery. Materials and Methods. The materials were the results of anamnestic profile clinical examinations and observations of patients (n = 118) who were on routine hospitalization in the profile department of the State Institution "Heart Institute of the Ministry of Health of Ukraine" in Kyiv. The study used a thematic map of the patient, developed and processed by the author. Its content was related to clinical prototypes associated with the leading symptoms of the disease and contributed to the understanding of the pathogenetic mechanisms of the latter. Results. The complex research, scientific-theoretical, methodological, and patent-licensing information on the specialty has shown that embolism is considered to be a priority mechanism for the development of hypoxic-ischemic lesions. Another important factor in the pathogenesis of hypoxic-ischemic disorders is hypoperfusion. One of the reasons for the development of stroke during cardiac surgery, especially in the surgical treatment of aortic pathology, is hypoperfusion due to instability of central hemodynamics. The next level of influence on systemic processes of development of hypoxic-ischemic defeats of the brain of cardiac surgery patients is the systemic inflammatory response. According to some researchers, CNS damage after cardiac surgery is largely due to side effects associated with the use of artificial circulation. An important point associated with the occurrence of hypoxic-ischemic changes in the brain is called general anesthesia. The technique of total intravenous and/or inhalation anesthesia does not provide adequate protection of CNS structures from intraoperative pain. Conclusions. Analysis of clinical and anamnestic materials on pathogenetic prototypes of hypoxic-ischemic lesions that occur in patients as a result of cardiac surgery, shows the presence of a complex of pathogenetic components, among which the leading role is played by: embolism; hypoperfusion; systemic inflammatory response with changes in hemostasis and the use of an arsenal of general anesthesia

Mechanisms of glycolysis and bioenergy state of cells at the stages of cardiosurgical interventions in patients with hypoxic — ischemic impairments of the brain

Objective — to study the features of bioenergetic provision of oxidative homeostasis (OH) in patients with hypoxic‑ischemic brain lesions (HIBL) before and after cardiac surgery (CS) using artificial circulation (AC).
 Methods and subjects. Clinical and biochemical studies were performed in 38 patients, including 14 with ischemic stroke, 15 with encephalopathy, and 9 with severe cognitive dysfunction.
 Results. Analysis of metabolic indicators of glycolysis activity and energy homeostasis of cells before and after CS revealed the patterns of changes in the disorganization of glycolysis mechanisms, intensification of anaerobic mechanisms while limiting the energy supply of cells. The obtained data confirm the formation of specific postoperative metabolic provision of bioenergy in patients with CS, which should be considered as one of the triggers of HIBL and individualization of antioxidant cerebroprotection in the preoperative period, taking into account the state of bioenergetic metabolism of cells and the dominant mechanisms of glycolysis.
 Conclusions. Preoperative antioxidant cerebroprotection as a means of prevention of hypoxic‑ischemic brain lesions during cardiac surgery using artificial circulation should be based on the determination of bioenergetic and metabolic reserves, the depletion of which by antioxidant drugs suppression should not be considered, as activation of anaerobic glycolysis at simultaneous metabolic suppression of mitochondrial bioenergetics is a factor of formation or aggravation of ischemic lesions of brain.

Enzymatic-metabolic support of oxidative homeostasis in patients with hypoxic-ischemic brain lesions in the stages of cardiosurgical interventions

To study the features of enzymatic and metabolic support of oxidative homeostasis in patients with hypoxic-ischemic brain lesions before and after cardiac surgery using artificial circulation we examined 38 patients, in particular: ischemic stroke — 14 people, encephalopathy — 15 people, severe cognitive dysfunction — 9 people ; diagnosis of neurological status was performed according to clinical protocols. Clinical and biochemical study was performed at the preoperative (3—5 days) and postoperative (5—7 days) stages: determined the content of superoxide dismutase, glutathione peroxidase, catalase in erythrocytes and α-tocopherol acetate in the serum of the blood, as well as the product cells: diene conjugates, metabolites of nitritanion in plasma. Variation statistics, probabilistic distribution of data with the subsequent estimation of reliability of results are applied; relative biochemical parameters were used: metabolic index, metabolic coefficient and metabolic effect for each. Standard methods using the program adapted to the “Excel” environment were used for calculations. The obtained data support the formation of patients with specific postoperative enzymatic-metabolic support of oxidative homeostasis, which should be considered as one of the triggers of hypoxic-ischemic brain lesions. In particular, at the level of the enzymatic chain of pro-, antioxidant protection and at the level of metabolic processes associated with peroxidation of phospholipids of cell membranes, a number of significant metabolic effects were revealed, which are generalized due to secondary oxidation products and NO‑dependent metabolites.

Время начала лечебной гипотермии и течение гипоксически-ишемической энцефалопатии у доношенных новорожденных

Актуальность. Современный стандарт проведения лечебной гипотермии у доношенных новорожденных детей с гипоксически-ишемической энцефалопатией требует начала гипотермии в течение первых шести часов жизни. Нерешенным остается вопрос о возможных преимуществах раннего начала гипотермии (в возрасте первого часа жизни) с учетом различных моделей проведения процедуры. Целью нашей работы было исследование связей между временем начала фазы пассивного охлаждения лечебной гипотермии и краткосрочными последствиями гипоксически-ишемической энцефалопатии. Материалы и методы. Анализ проявлений гипоксически-ишемической энцефалопатии проводился в зависимости от времени начала гипотермии: в первый час жизни или в течение первых 2–6 часов жизни. Результаты. В исследование включены 129 доношенных новорожденных с асфиксией при рождении, которым проводилась лечебная гипотермия (модель системной гипотермии с использованием простых средств охлаждения). Среди младенцев с ранним началом охлаждения в 27,7 % (23/83) случаях течение гипоксически-ишемической энцефалопатии было неблагоприятным. Среди новорожденных с более поздним началом гипотермии 36,1 % (13/46) детей имели неблагоприятное течение гипоксически-ишемической энцефалопатии. Не установлены достоверные различия между группами с разным временем начала пассивного охлаждения относительно частоты регистрации деструктивных гипоксически-ишемических поражений мозга и летальных случаев вследствие развития постишемического отека мозга и полиорганной недостаточности (p = 0,551). Между группами наблюдения выявлены достоверные различия центральной температуры на момент госпитализации в отделение интенсивной терапии (33,17 ± 0,11 °С против 33,85 ± 0,18 °C), возраста достижения целевой температуры (4,64 ± 0,65 часа против 7,52 ± 1,35 часа), продолжительности госпитализации в неонатальном стационаре (27,3 ± 1,4 дня против 33,8 ± 2,7 дня, р = 0,020). Выводы. Не выявлены достоверные отличия краткосрочных последствий гипоксически-ишемического поражения в зависимости от времени начала пассивного охлаждения в пределах первых 6 часов жизни. Однако младенцы, подлежащие пассивному охлаждению в течение первого часа жизни, имели более низкие значения центральной температуры на момент госпитализации и быстрее достигали целевой температуры охлаждения.

Neuroprotective Effect of Maternal Resveratrol Supplementation in a Rat Model of Neonatal Hypoxia-Ischemia.

Neonatal hypoxia-ischemia (nHI) is a major cause of death or subsequent disabilities in infants. Hypoxia-ischemia causes brain lesions, which are induced by a strong reduction in oxygen and nutrient supply. Hypothermia is the only validated beneficial intervention, but not all newborns respond to it and today no pharmacological treatment exists. Among possible therapeutic agents to test, trans-resveratrol is an interesting candidate as it has been reported to exhibit neuroprotective effects in some neurodegenerative diseases. This experimental study aimed to investigate a possible neuroprotection by resveratrol in rat nHI, when administered to the pregnant rat female, at a nutritional dose. Several groups of pregnant female rats were studied in which resveratrol was added to drinking water either during the last week of pregnancy, the first week of lactation, or both. Then, 7-day old pups underwent a hypoxic-ischemic event. Pups were followed longitudinally, using both MRI and behavioral testing. Finally, a last group was studied in which breastfeeding females were supplemented 1 week with resveratrol just after the hypoxic-ischemic event of the pups (to test the curative rather than the preventive effect). To decipher the molecular mechanisms of this neuroprotection, RT-qPCR and Western blots were also performed on pup brain samples. Data clearly indicated that when pregnant and/or breastfeeding females were supplemented with resveratrol, hypoxic-ischemic offspring brain lesions were significantly reduced. Moreover, maternal resveratrol supplementation allowed to reverse sensorimotor and cognitive deficits caused by the insult. The best recoveries were observed when resveratrol was administered during both gestation and lactation (2 weeks before the hypoxic-ischemic event in pups). Furthermore, neuroprotection was also observed in the curative group, but only at the latest stages examined. Our hypothesis is that resveratrol, in addition to the well-known neuroprotective benefits via the sirtuin’s pathway (antioxidant properties, inhibition of apoptosis), has an impact on brain metabolism, and more specifically on the astrocyte-neuron lactate shuttle (ANLS) as suggested by RT-qPCR and Western blot data, that contributes to the neuroprotective effects.

Compression-hypoxic birth injuries and skull configuration

The fetus has birth traumatic, compression-hypoxic, and hypoxic-ischemic brain lesions during childbirth. There are problems in their differentiation in clinical and anatomopathological practice. It is proposed to divide birth traumatic injuries into two types: 1) obvious traumatic injuries and 2) compression-hypoxic traumatic injuries. Signs of compression-hypoxic birth injuries were found in 24.4% of the examined fetuses and newborns delivered via vacuum extraction and application of obstetric forceps. This allows compression hypoxia to be attributed to birth injury rather than to hypoxic-ischemic encephalopathy. It is proposed to use the concept of compression-hypoxic birth injury. The morphological signs that are characteristic of this type of birth injury are given. It is indicated that the impact of physical forces on the fetal head is mediated by its configuration. The mechanisms of birth traumatic injuries are systematized. The pathological configuration of the fetal head is shown to be of importance in explaining the cause of birth injury.

Near-infrared spectroscopy: bilateral brain monitoring in termed newborns with hypoxic-ischemic lesions.

Assessment of cerebral oxygenation using near-infrared spectroscopy (near-infrared spectroscopy, near-infrared spectroscopy, NIRS) has significant strong correlation with the assessment of brain perfusion using MRI in full-term infants with severe hypoxic-ischemic encephalopathy. However, there are still no recommendations on the use of NIRS monitoring data for making important clinical decisions in newborns with asphyxia and hypoxic-ischemic encephalopathy in routine clinical practice. The role of interhemispheric variations in the values of regional tissue oxygen saturation (rSO2) in severe hypoxic-ischemic encephalopathy against the background of therapeutic hypothermia remains unexplored. The aim of the study was to evaluate the results of bilateral brain monitoring using NIRS in full-term newborns with severe hypoxic-ischemic lesions (with and without destructive changes in brain tissue). All examined children were full-term newborns with severe asphyxia at birth, who underwent therapeutic hypothermia. We analyzed the results of NIRS recordings of 33 newborns who did not have signs of destructive hypoxic-ischemic brain damage, and NIRS data of 15 newborns who were diagnosed with signs of destructive hypoxic-ischemic brain damage. The hemisphere difference in cerebral oximetry indices was presented in the form of statistical processing results - average, median, mode, 25th percentile, 75th percentile of pairwise comparisons, namely the difference of values (ΔrSO2) of the measurement “ΔrSO2=rSO2on the right-rSO2on the left” in each moment of recording (12000-22000 measurement moments during the monitoring session), as well as the percentage of recording time when the ΔrSO2 value was recorded below the 25th percentile and above the 75th percentile. Reliable correlations between the fact of the formation of destructive hypoxic-ischemic brain lesions in full-term newborns and the average ΔrSO2 values of the NIRS record (R=-0.410), median values (R=-0.400), modes (R=-0.357), and values 25-the percentile ΔrSO2 (R=-0.326) and the 75th percentile ΔrSO2 (R=-0.429) were registered. In 73.3% of children with destructive hypoxic-ischemic lesions, the average ΔrSO2 values were higher for the right hemisphere (the average ΔrSO2 value of the group was 0.11±2.39%). In 93.9% of children without destructive brain damage, the average rSO2 values were higher for the right hemisphere (the average ΔrSO2 value of the group was 6.92±0.80%). Significant differences in mean ΔrSO2 (p=0.005) were determined. Mean ΔrSO2 median for the group with destructive brain lesions was 0.33±2.38%, for the group without destructive lesions - 6.88±0.82% (p=0.004), the average ΔrSO2 mode for the group with destructive brain lesions was 1,46±1.73%, for the group without destructive lesions - 6.51±0.92% (p=0.014). The average of the 25th percentile of ΔrSO2 values for the group with destructive brain lesions was (-1.93)±2.72%, and for the group without destructive lesions it was 4.42±0.84% (p=0.026). The average of the 75th percentile of ΔrSO2 values for the group with destructive brain lesions was 2.87±2.11%, and for the group without destructive lesions it was 9.33±0.80% (p=0.003). The results of bilateral brain monitoring using NIRS in full-term newborns with severe hypoxic-ischemic lesions on the background of therapeutic hypothermia have significant dif­ferences between groups of children with and without destructive changes in brain tissue. In newborns with destructive brain lesions, a decrease in manifestations of dominance of rSO2 indicators of the right hemisphere was recorded, namely, significantly lower mean ΔrSO2, median, mode, average values of the 25th and 75th percentiles ΔrSO2.

MODERN ASPECTS OF HYPOXICISCHEMIC ENCEPHALOPATHY IN NEWBORNS

The article presents modern aspects of the pathogenesis of hypoxic-ischemic brain lesions in newborns. The pathophysiological mechanisms of development (phases of energy deficiency features of glutamatin receptor metabolism, role inflammation, gender characteristics and gene polymorphism) of hypoxic-ischemic encephalopathy in newborns are presented.

Hypoxic-ischemic brain damage in premature newborns

One of the main causes of cerebral dysfunction in premature newborns is hypoxia. High mortality and lifelong morbidity in these children is a frequent result of neonatal hypoxic brain damage. The article presents some data on the prevalence of neurological diseases that have arisen in the perinatal period, and highlights the key etiological factors leading to hypoxia in both the intranatal and early postnatal periods. The pathogenesis of hypoxic-ischemic brain lesions in premature infants is described in detail. At the same time, more careful consideration is given to the glutathione system, which protects against lipid peroxidation, the glutamate-calcium cascade, and the excitotoxicity mediated by it, as well as the processes of necrosis and apoptosis of nerve cells. The advantages and disadvantages of modern methods for diagnosing cerebral lesions are noted, and the principles of treatment of these disorders are analyzed.

Recent Information on the Pathogenesis and Treatment of Hypoxic-Ischemic Brain Lesions in Newborns

Hypoxic-ischemic brain lesions in children are the main environmental (non-genetic) factor in forming severe neurological pathology with subsequent disability. Scientists see the improvement of therapeutic approaches in acute phase of the disease as a main way to reduce the severity of neurologic complications. Due to the achievements in neuroscience in the field of perinatal hypoxicischemic injury mechanisms, three energy phases of pathologic events deployment were identified: primary (up to 6 hours from the lesion), secondary (6 to 24–48 h after the lesion) and distal tertiary (during few weeks, months). At the same time, necrosis, apoptosis, glutamate excitotoxicity, oxidative stress, inflammation, angiogenesis and neurogenesis make up separate links of destruction process. On the basis of new data on the pathogenesis of the disease, scientists from different countries have already offered modern treatment methods for perinatal hypoxic-ischemic injury with erythropoietin, allopurinol, melatonin, N-acetylcysteine, magnesium sulphate, albumin, -interferon, as well as with the help of controlled hypothermia, xenon, the use of stem cells, etc. This article presents a review of new data on pathogenesis and promising treatment methods for perinatal hypoxic-ischemic injuries.

NMDA receptor blockade in the developing cortex induces autophagy-mediated death of immature cortical GABAergic interneurons: An ex vivo and in vivo study in Gad67-GFP mice

In neonates, excitotoxicity is a major process involved in hypoxic–ischemic brain lesions, and several research groups have suggested the use of NMDA antagonists for neuroprotection. However, despite their clinical interest, there is more and more evidence suggesting that, in the immature brain, these molecules exert deleterious actions on migrating GABAergic interneurons by suppressing glutamatergic trophic inputs. Consequently, preventing the side effects of NMDA antagonists would be therapeutically useful. Because macroautophagy is involved in the adaptive response to trophic deprivation, the aim of the present study was to investigate the impact of autophagy modulators on the MK801-induced death of immature GABAergic interneurons and to characterize the crosstalk between autophagic and apoptotic mechanisms in this cell type. Ex vivo, using cortical slices from NMRI and Gad67-GFP mice, we show that blockade of the NMDA receptor results in an accumulation of autophagosomes due to the disruption of the autophagic flux. This effect precedes the activation of the mitochondrial apoptotic pathway, and the degeneration of immature GABAergic neurons present in developing cortical layers II–IV and is prevented by 3-MA, an autophagy inhibitor. In contrast, modulators of autophagy (3-MA, rapamycin) do not interfere with the anti-excitotoxic and neuroprotective effect of MK801 observed in deep layers V and VI. In vivo, 3-MA blocks the rapid increase in caspase-3 cleavage induced by the blockade of NMDA receptors and prevents the resulting long-term decrease in Gad67-GFP neurons in layers II–IV. Together, these data suggest that, in the developing cortex, the suppression of glutamatergic inputs through NMDA receptor inhibition results in the impairment of the autophagic flux and the subsequent switch to apoptotic death of immature GABAergic interneurons. The concomitant inhibition of autophagy prevents this pro-apoptotic action of the NMDA blocker and favors the long-term rescue of GABAergic interneurons without interfering with its neuroprotective actions. The use of autophagy modulators in the developing brain would create new opportunities to prevent the side effects of NMDA antagonists used for neuroprotection or anesthesia.

USE OF DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING FOR REVEALING HYPOXIC-ISCHEMIC BRAIN LESIONS IN NEONATES

The article presents advantages of use of diffusion-weighted magnetic resonance imaging (DW MRI) for revealing hypoxic-ischemic brain lesions in neonates. The trial included 97 neonates with perinatal brain lesion who had been undergoing treatment at a resuscitation department or neonatal pathology department in the first month of life. The article shows high information value of diffusion-weighted images (DWI) for diagnostics of hypoxic-ischemic lesions in comparison with regular standard modes. In the event of no structural brain lesions of neonates, pronounced increase in signal characteristics revealed by DWI indicated considerable pathophysiological alterations. Subsequently, children developed structural alterations in the form of cystic encephalomalacia with expansion of cerebrospinal fluid spaces manifested with pronounced neurological deficit. DW MRI has been offered as a method of prognosticating further neurological development of children on early stages.

Zmiany niedotlenieniowo-niedokrwienne w badaniu MR ośrodkowego układu nerwowego u noworodków donoszonych i urodzonych przedwcześnie - obrazy typowe i rzadziej spotykane

Hypoxic-ischemic brain injury occurring in antenatal, perinatal or early postnatal period constitutes an important diagnostic problem in both term and prematurely born neonates. Over the past several years magnetic resonance imaging (MRI) has become relatively easily accessible in Poland. On the basis of the central nervous system MRI, the experienced radiologist are able to determine the location of the hypoxic-ischemic lesions, their extent and evolution. Therefore he can help clinicians to answer the question whether the brain damage of the newborn is responsible for its clinical condition and he can contribute to determining the prognosis of the infant's future development. The aim of this study is to present the current knowledge of different types of hypoxic-ischemic brain lesions based on our personal experience and MR images from the archives of the Department of Diagnostic Imaging at the Institute of Mother and Child.

The value of electroencephalography in the diagnosis and prognosis of the likely outcomes hypoxic-ischemic brain lesions in term neonates

In practice it’s often observed the discrepancy between clinical presentation of cerebral lesions in neonates and results of instrumental studies (neurosonography and computer tomography). The aim of the research was to explore the possibilities of the method of EEG for diagnosis and prognosis of cerebral lesions in neonates. The study was carried out in the design of Longitudinal prospective cohort controlled comparative non-randomized study with a simple glare. The study results demonstrate a great diagnostic and prognostic value of the method of EEG in detecting cerebral ischemia in neonates.

What do we know about sociocognitive development of children with pre/perinatal lesions?

There is a great deal of data on the cognitive and linguistic development of children with pre/perinatal lesions of the brain in literature, but there has been little research into their socio-cognitive development. Therefore, the aim of this study was to assess early sociocognitive abilities in children with pre/perinatal brain lesions and compare the results with the sociocognitive abilities of children with typical development. The study included 12 children with peri-intraventricular haemorrhages and/or hypoxic-ischemic brain lesions (aged 12 months) and 12 children without neurodevelopmental risk who were involved in wider neuropediatric, speech and language and psychological follow-up. The children were assessed and recorded interacting with their parents in the Developmental Neurolinguistics Laboratory. Data regarding the child’s communicative behavior in everyday situations was gathered using structural interviews with the parents. The results indicate that children with early brain lesions show a normal pattern of development of social cognition but also that they reach the milestones of normal sociocognitive development somewhat later in early development.

Do Apparent Diffusion Coefficient Measurements Predict Outcome in Children with Neonatal Hypoxic-Ischemic Encephalopathy?

Diffusion-weighted imaging (DWI) permits early detection and quantification of hypoxic-ischemic (HI) brain lesions. Our aim was to assess the predictive value of DWI and apparent diffusion coefficient (ADC) measurements for outcome in children with perinatal asphyxia. Term neonates underwent MR imaging within 10 days after birth because of asphyxia. MR imaging examinations were retrospectively evaluated for HI brain damage. ADC was measured in 30 standardized brain regions and in visibly abnormal areas on DWI. In survivors, developmental outcome until early school age was graded into the following categories: 1) normal, 2) mildly abnormal, and 3) definitely abnormal. For analysis, category 3 and death (category 4) were labeled "adverse," 1 and 2 were "favorable," and 2-3 and death were "abnormal" outcome. Differences in outcome between infants with and without DWI abnormalities were analyzed by using chi(2) tests. The nonparametric Mann-Whitney U test analyzed whether ADC values in visible DWI abnormalities correlated with age at imaging. Logistic regression analysis tested the predictive value for outcome of the ADC in each standardized brain region. Receiver operating characteristic analysis was used to find optimal ADC cutoff values for each region for the various outcome scores. Twenty-four infants (13 male) were included. Mean age at MR imaging was 4.3 days (range, 1-9 days). Seven infants died. There was no difference in outcome between infants with and without visible DWI abnormalities. Only ADC of the posterior limb of the internal capsule correlated with age. ADC in visibly abnormal DWI regions did not have a predictive value for outcome. Of all measurements performed, only the ADC in the normal-appearing basal ganglia and brain stem correlated significantly with outcome; low ADC values were associated with abnormal/adverse outcome, and higher ADC values, with normal/favorable outcome (basal ganglia: P = .03 for abnormal, P = .01 for adverse outcome; brain stem: P = .006 for abnormal, P = .03 for adverse outcome). ADC values in normal-appearing basal ganglia and brain stem correlated with outcome, independently of all MR imaging findings including those of DWI. ADC values in visibly abnormal brain tissue on DWI did not show a predictive value for outcome.

Prenatal Diagnosis of Vein of Galen Malformation: A Multidisciplinary Challenge

Vein of Galen aneurysmal malformation (VGAM) is a rare congenital arteriovenous malformation of the choroid plexus situated within the roof of the third ventricle. If large, it leads to an extracardiac left-to-right shunt featuring as a high output heart failure in the neonate. In our case of VGAM, hypoxic-ischemic brain lesions due to the steal phenomenon could be demonstrated prenatally. In a multidisciplinary clinical setting, withdrawal of active care and initiation of good end-of-life care was decided on and carried through.