Ahmed Atif, Basile Eric J, Ahmad Myra, Blair Jeffrey R, Ahmad Hamzah, Ahmad Salman, Roche Patricia E
Physical Medicine and Rehabilitation, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, New York, USA.
Internal Medicine, Touro College of Osteopathic Medicine, New York, USA.
Cureus. 2021 Dec 23;13(12):e20634. doi: 10.7759/cureus.20634. eCollection 2021 Dec.
Each year there are an estimated 1.7 million adults in the United States that develop sepsis and nearly 16% of these adult patients die because of this disease process. Sepsis, however, can impact patients of all ages. Neonatal sepsis is currently one of the leading causes of morbidity and mortality among neonates. There are many complications of neonatal sepsis including meningitis, seizures, and hypoxic ischemic encephalopathy (HIE). HIE is estimated to impact one to five in 1000 live births worldwide, primarily impacting neonates. It is more commonly seen in premature infants and infants with low birth weights due to immature organ systems and a lack of adequate auto-regulatory mechanisms that would otherwise manage brain perfusion. In premature neonates, the most commonly recognized pathological pattern found on MRI is focal non-cystic white matter injury. HIE can also impact term infants as well. In these neonates, there exist two common MRI patterns that include either basal ganglia-thalamus ischemia, most often involving deep gray nuclei and perirolandic cortex, or watershed predominant ischemic changes that involve cortical gray matter. We report a 38-week-old male neonate born at gestation diagnosed with HIE secondary to neonatal sepsis with an MRI finding of isolated insular cortex hypersensitivity on fluid-attenuated inversion recovery (FLAIR) and T1-weighted imaging. Isolated insular cortex hypersensitivity can be seen in non-lacunar ischemic middle cerebral artery (MCA) territory strokes but it is not common for it to present as a sole finding. In our case, these findings persisted for several weeks without evidence of any common patterns of hypoxia-induced cerebrovascular insult on MRI imaging.
据估计，美国每年有170万成年人发生脓毒症，其中近16%的成年患者死于这一疾病过程。然而，脓毒症可影响所有年龄段的患者。新生儿脓毒症目前是新生儿发病和死亡的主要原因之一。新生儿脓毒症有许多并发症，包括脑膜炎、癫痫和缺氧缺血性脑病（HIE）。据估计，全球每1000例活产中就有1至5例受HIE影响，主要是新生儿。由于器官系统不成熟以及缺乏能够调节脑灌注的充分自动调节机制，HIE在早产儿和低体重儿中更为常见。在早产儿中，MRI上最常见的病理模式是局灶性非囊性白质损伤。HIE也可影响足月儿。在这些新生儿中，存在两种常见的MRI模式，一种是基底节-丘脑缺血，最常累及深部灰质核团和中央旁皮质，另一种是分水岭为主的缺血性改变，累及皮质灰质。我们报告了一名38周妊娠出生的男婴，诊断为新生儿脓毒症继发HIE，MRI检查发现液体衰减反转恢复（FLAIR）和T1加权成像上孤立的岛叶皮质高敏性。孤立的岛叶皮质高敏性可见于非腔隙性缺血性大脑中动脉（MCA）区域卒中，但单独出现并不常见。在我们的病例中，这些发现持续了数周，MRI成像上没有任何缺氧性脑血管损伤的常见模式的证据。
