Bokiniec Renata, Bekiesińska-Figatowska Monika, Rudzińska Iwona, Borszewska-Kornacka Maria Katarzyna
Ginekol Pol. 2014 Dec;85(12):933-8. doi: 10.17772/gp/1885.
Hypoxic ischemic insults during labor remain an important cause of brain injury in term and near-term neonates. Selective cerebral hypothermia is a potentially neuroprotective rescue therapy. Ultrasonography (US) and magnetic resonance imaging (MRI) are routinely used to visualize intracranial changes in neonatal hypoxic-ischemic injuries.
We attempted to describe all pathological findings on US and MRI in the brains of our patients following selective cerebral hypothermia.
Twenty-nine neonates with hypoxic-ischemic encephalopathy (HIE) following therapeutic cooling were assessed with cranial ultrasound (US) and magnetic resonance imaging (MRI). The findings were compared with the clinical outcome.
Over one-fourth (27.6%) of the examined infants had a normal brain on MRI (with only 17.2% on US). Involvement of the basal ganglia and thalami was one of the most frequent findings in our material (9/29 = 31% on MRI, and 7/29-24.1% on US). Cerebral parenchymal hemorrhage was detected on MRI in as many as 7 (24.1%) and cerebellar parenchymal hemorrhage in 4 (13.8%) infants. The loss in the gray-white matter differentiation ('fuzzy brain'), usually transient on US, was observed in 79.3% of the neonates. Diffusion restriction in the callosal splenium (13.8%) and hyperechoic thalami and basal ganglia were strictly correlated to a significantly higher incidence of severe developmental delay.
Abnormalities on MRI and US were observed in 75% of newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia.
分娩期间的缺氧缺血性损伤仍是足月儿和近足月儿脑损伤的重要原因。选择性脑低温是一种具有潜在神经保护作用的抢救治疗方法。超声（US）和磁共振成像（MRI）常用于观察新生儿缺氧缺血性损伤时的颅内变化。
我们试图描述接受选择性脑低温治疗的患者脑部超声和MRI的所有病理结果。
对29例治疗性降温后患有缺氧缺血性脑病（HIE）的新生儿进行了头颅超声（US）和磁共振成像（MRI）评估。将结果与临床结局进行比较。
超过四分之一（27.6%）的受检婴儿MRI显示脑部正常（超声检查时仅为17.2%）。基底神经节和丘脑受累是我们研究材料中最常见的发现之一（MRI检查时为9/29 = 31%，超声检查时为7/29 - 24.1%）。MRI检查发现多达7例（24.1%）婴儿有脑实质出血，4例（13.8%）婴儿有小脑实质出血。79.3%的新生儿观察到灰-白质分化消失（“模糊脑”），通常在超声检查时为短暂现象。胼胝体压部的扩散受限（13.8%）以及丘脑和基底神经节高回声与严重发育迟缓的发生率显著升高密切相关。
接受治疗性低温治疗的缺氧缺血性脑病新生儿中，75%的患儿MRI和US检查显示异常。
