5 day old 37 week gestation infant delivered by emergency C-section after placental abruption. Low APGARs status post cooling protocol now with seizures. Evaluate for hypoxic ischemic injury. There is diffuse patchy mildly restricted diffusion throughout the supratentorial brain with more conspicuous restricted diffusion to diffuse in the corpus callosum. There is relative sparing of the cerebellum. The cerebral cortex demonstrates diffuse subtle increased T2 and decreased T1 signal, along with blurring of the gray-white junction, compatible with cerebral edema. Abnormal signal is also identified along the brainstem. The deep gray nuclei demonstrate prominent patchy areas of increased T1 signal. Normal T1 hyperintense and T2 hypointense signal in the posterior limb of internal capsules is not visualized. The constellation of findings is compatible with hypoxic ischemic encephalopathy.There is associated local mass effect with diffuse effacement of the cortical sulci and perhaps minimal decrease in size of the lateral ventricles. The basal cisterns remain patent. No evidence of herniation.No evidence of intracranial hemorrhage. The expected intracranial vascular flow voids are present.The middle ears and mastoid air cells are opacified with fluid. The orbits are unremarkable. There is a moderate occipitoparietal caput succedaneum.
1. Diffusely abnormal signal in the supratentorial brain and brainstem as described, compatible with hypoxic ischemic encephalopathy.2. More conspicuous diffusion restriction diffusely to the corpus callosum which may relate to acute neuronal degeneration.3. Nonspecific fluid opacification of bilateral middle ears and mastoids.