Radiological Findings in a Neonate with Seizure: Discussion Based Approach

Findings: 5 day old full term  neonate with seizures . MRI shows non hemorrhagic  infarction in anteromedial  left thalamus  with rest grossly  normal for age 

FAQs

1. What is the abnormality?

Left thalamus in the antero medial nuclei location shows restricted diffusion with reduced ADC values with no haemorrhage / intraventricular  bleed/ midline shift/ herniation with unremarkable PCA flow void/ unremarkable watershed zones 

2. How do we  interpret this?

Radiologically could rep overlap of the two most common aetiologies of hypoglycaemia(anteromedial thalamic nuclei +) and HIE (thalamus is involved in Acute profound variety

3. Does the picture suggest " Radiological hypoglycaemia"?

No classically it should have been watershed zones involvement  in severe  hypoglycaemia  OR

Symmetrical post white matter/ grey matter/ pulvinar and anteromedial thalamic nuclei   to be labelled as Radiological hypoglycaemia 

4. What  is  def of laboratory hypoglycaemia?

Appx less than 46mg/dL in radiology literature 

5. Is the thalamic haemorrhage different ?

Thalamic haemorrhage should point towards deep cerebral venous thrombosis  particularly straight sinus with status epilepticus 

6. Can we  have normal MRI in HIE?

Yes they are common

7. How do we conclude HIE for routine radiologist ?

Four abnormal imaging patterns sump HIE 

     (a) watershed  (b) basal ganglia (c)  total, and (d) focal-multifocal brain  injuries

Two types of HIE are described 

(a)Prolonged partial asphyxia results in a pattern of injury that primarily involves the watershed zones between the major intravascular boundary zones,

 (b)Acute profound asphyxia results in the basal ganglia–predominant pattern of brain injury  involves the basal ganglia, thalami , brainstem (refd to as BGT lesions)  , sensorimotor cortex, and corticospinal tracts