Background: Hypoxic Ischemic Encephalopathy is defined as a heterogeneous, clinically defined syndrome characterized by disturbed neurologic function in the earliest days of life in a neonate. Proton MR spectroscopy could reveal brain ischemic injuries in asphyxiated neonates earlier than T1-or T2-weighted MR imaging. MR spectroscopy and MR imaging are very important for the diagnosis of hypoxic-ischemic injury. Patients and Methods: A cross-sectional study. From December 2018 to December 2019, 50 full-term neonates were admitted to Neonatal Care Unit (NCU) in Sohag University Hospital with signs of HIE and referred to the Radio Diagnosis Department for brain imaging. MR imaging studies were performed using an MRI system 1.5 tesla Achieva, Philips superconductive MRI system. Our MRI sequences 1. Axial T1WI. 2. Axial T2WI. 3. Axial FLAIR. 4. Axial DWI. 5. proton MR spectroscopy Results: The study included 50 neonates; 7 of them had normal MRI findings. The other 43 neonates showed different patterns of injury; 24 neonates showed a central pattern of injury,11 neonates show peripheral patterns of injury, While the other 8 neonates had shown both central and peripheral patterns of brain injury. Only 45 of the examined neonates show abnormal lactate peak. The sensitivity of MRS is 100%. However, the specificity is low 70 %, the overall accuracy is 60 %. Conclusion: MR spectroscopy is an accurate, sensitive, and non-invasive method for early detection of perinatal ischemic brain injuries.