Frequency of ulegyria on delayed MRI scans in children with term hypoxic-ischemic injury

Stern, Joseph A.; Elsingergy, Mohamed; Venkatakrishna, Shyam Sunder B.; Worede, Fikadu; Curic, Jelena; Andronikou, Savvas

doi:10.1007/s00247-022-05445-0

Cited by 5 publications

(7 citation statements)

References 15 publications

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“…Conversely, ulegyria, which is distinct from the smooth bulging lobulated cerebral mantle seen in multicystic encephalomalacia and is typical of watershed injury, 24 was statistically more frequently seen in the focal‐cystic group. According to Shroff et al., multicystic encephalomalacia is the consequence of extensive injury, while ulegyria is due to localized injury in the chronic stage of evolution 25 .…”

Section: Discussionmentioning

confidence: 92%

“…22 This further is supported by Reid et al who found that globus pallidi involvement was a great predictor of severity and corresponded to more hemispheric injury in a similar cohort of cerebral palsy patients with GMI. 23 Conversely, ulegyria, which is distinct from the smooth bulging lobulated cerebral mantle seen in multicystic encephalomalacia and is typical of watershed injury, 24 was statistically more frequently seen in the focal-cystic group. According to Shroff et al, multicystic encephalomalacia is the consequence of extensive injury, while ulegyria is due to localized injury in the chronic stage of evolution.…”

Section: Discussionmentioning

confidence: 98%

“…Both the importance of delayed MRI and the appearance of chronic HII findings on delayed MRI have been described in the literature previously and are relevant in the developing world where there are resource constraints. 20,21,23,24,30,31…”

Section: Discussionmentioning

confidence: 99%

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Distinguishing multicystic from focal encephalomalacia on delayed MRI in children with term hypoxic ischemic injury

Alkhulaifat,

Venkatakrishna,

Alves

et al. 2024

Journal of Neuroimaging

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Background and PurposeTo define cystic patterns resulting from term hypoxic ischemic injury (HII) on delayed Magnetic Resonance Imaging (MRI) and determine associated HII patterns and lesions that reflect the severity of injury, from a database of African children with cerebral palsy.MethodsRetrospective review of 1175 children with cerebral palsy due to term HII diagnosed on late MRI, identifying those with cystic changes. These were classified as multicystic or (multi‐) focal‐cystic, and were evaluated for associated injuries—thalami, basal ganglia, hippocampi, cerebellum, and presence of ulegyria.ResultsThree hundred and eighty‐eight of 1175 (33%) children had cystic encephalomalacia. Two hundred and seven of 388 (53.3%) had focal‐cystic and 181/388 (46.6%) had multicystic injury. The focal‐cystic group comprised 87.9% (182/207) with thalamic injury, 25.6% (53/207) with basal ganglia injury, and 15% (31/207) with cerebellar involvement. Basal‐ganglia‐thalamus (BGT) pattern was present in 43.9% (91/207) and ulegyria in 69.6% (144/207). In the multicystic group, 88.9% (161/181) had thalamic injury, 30.9% (56/181) had basal ganglia injury, and 21% (38/181) had cerebellar involvement. BGT pattern was observed in 29.8% (54/181) and ulegyria in 28.7%. (52/181). Significant associations (p<.05) were found between multicystic injury and caudate/globus pallidus involvement, and between focal‐cystic pattern of injury and ulegyria.ConclusionsCystic encephalomalacia was seen in almost one‐third of patients with term HII imaged with delayed MRI, with a similar prevalence of focal‐cystic and multicystic injury. Multicystic injury was associated with caudate and globus pallidi involvement, typical of the BGT pattern of HII, whereas the focal‐cystic pattern was associated with ulegyria, typical of watershed injury.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 98%

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Distinguishing multicystic from focal encephalomalacia on delayed MRI in children with term hypoxic ischemic injury

Alkhulaifat,

Venkatakrishna,

Alves

et al. 2024

Journal of Neuroimaging

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“…In a study by Elsingergy et al, 18 the authors recommended performing delayed MRI in children with cerebral palsy with suspected perinatal HII even if there was no imaging in the perinatal period. Limited published literature is available dealing with chronic HII findings and their appearance on delayed MRI, which may be particularly important in resource-limited health settings 2,12,18–21 …”

Section: Discussionmentioning

confidence: 99%

“…Limited published literature is available dealing with chronic HII findings and their appearance on delayed MRI, which may be particularly important in resource-limited health settings. 2,12,[18][19][20][21] Magnetic resonance imaging appearances evolve because of a variety of reasons such as normal brain development, compensatory mechanisms, and degeneration that occurs secondary to the initial injury. 22 It has been reported that chronicity may accentuate the imaging findings and the extent of injury through the atrophy and signal change that occurs.…”

Section: Discussionmentioning

confidence: 99%

Unequal Cerebral Magnetic Resonance Imaging Changes in Perinatal Hypoxic Ischemic Injury of Term Neonates

Venkatakrishna

Elsingergy

Worede

et al. 2023

J Comput Assist Tomogr

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Background Perinatal hypoxic ischemic injury (HII) has a higher prevalence in the developing world. One of the primary concepts for suggesting that an imaging pattern reflects a global insult to the brain is when the injury is noted to be bilateral and symmetric in distribution. In the context of HII in term neonates, this is either bilateral symmetric (a) peripheral/watershed (WS) injury or (b) bilateral symmetric basal-ganglia-thalamus (BGT) pattern, often with the peri-Rolandic and hippocampal injury. Unilateral, asymmetric, or unequal distribution of injury may therefore be misdiagnosed as perinatal arterial ischemic stroke. Objectives We aimed to determine the prevalence of unequal cerebral injury in HII, identify patterns, and determine their relationship with existing classification of HII. Materials and Methods Review of brain magnetic resonance imaging from a database of children with HII. Reports with any unequal pattern of injury were included and further classified as a unilateral, bilateral asymmetric, or symmetric but unequal degree pattern of HII. Results A total of 1213 MRI scans in patients with a diagnosis of HII revealed 156 (13%) with unequal involvement of the hemispheres: unilateral in 2 of 1213 (0.2%) (involvement only in the WS), asymmetric in 48 of 1213 (4%) (WS in 6 [0.5%], BGT in 4 [0.3%], and combined BGT and WS in 38 [3.1%]), and bilateral symmetric but unequal degree in 106 of 1213 (8.7%) (WS in 20 [1.6%], BGT in 17 [1.4%], and combined BGT and WS in 69 [5.7%]). Conclusions The majority of children with cerebral palsy due to HII demonstrate a characteristic bilateral symmetric pattern of injury. In our study, 13% demonstrated an unequal pattern. Differentiation from perinatal arterial ischemic stroke, which is mostly unilateral and distributed typically in the middle cerebral artery territory, should be possible and recognition of the typical BGT or WS magnetic resonance imaging patterns should add confidence to the diagnosis, in such scenarios.

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Distribution of IntraThalamic Injury According to Nuclei and Vascular Territories in Children With Term Hypoxic-Ischemic Injury

Tierradentro-García¹,

Elsingergy²,

Nel³

et al. 2023

Pediatric Neurology

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Frequency of ulegyria on delayed MRI scans in children with term hypoxic-ischemic injury

Cited by 5 publications

References 15 publications

Distinguishing multicystic from focal encephalomalacia on delayed MRI in children with term hypoxic ischemic injury

Distinguishing multicystic from focal encephalomalacia on delayed MRI in children with term hypoxic ischemic injury

Unequal Cerebral Magnetic Resonance Imaging Changes in Perinatal Hypoxic Ischemic Injury of Term Neonates

Distribution of IntraThalamic Injury According to Nuclei and Vascular Territories in Children With Term Hypoxic-Ischemic Injury

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