13-day-old male with low Apgars at birth, evidence of ischemic damage to the liver. Concern for hypoxic ischemic encephalopathy. Plan to wean off iNO overnight. Per chart review, patient is an ex-37 2/7 infant male patient born via emergent c-section to a 31-yo G2P2 mother secondary to placental abruption. He remains in stable condition as his LFTs and ammonia levels have been decreasing, but continues to require aggressive NICU management given likely multiorgan involvement from mixed acute on chronic hypoxic-ischemic injury. Today there is plan to wean NO and hydrocortisone and going up on feeds. There are foci of restricted diffusion in the periventricular white matter along the trigone of the lateral ventricles, left greater than right, which demonstrates increased T1 and T2/FLAIR hyperintensity. Otherwise the remaining brain parenchyma is unremarkable; specifically there is no cortical or deep gray matter signal abnormality.. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Findings compatible with focal ischemic infarcts within the periventricular white matter adjacent to the trigone of the lateral ventricles, left greater than right. Otherwise the cortical and deep gray matter signal is within normal limits. No acute hemorrhage.