Very Low-Voltage Background Activity; Hypoxic-Ischemic Encephalopathy (HIE). A 6-day-old infant who was born at term with Apgar scores of 0, 0, 0, 3, 4,

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Presentation transcript:

Very Low-Voltage Background Activity; Hypoxic-Ischemic Encephalopathy (HIE). A 6-day-old infant who was born at term with Apgar scores of 0, 0, 0, 3, 4, 6, and 7 at 1, 5, 10, 15, 20, 25, and 30 min of life. The infant was cyanotic, depressed, and floppy at delivery and received intubation, chest compressions, and epinephrine. He underwent head cooling. MRI performed at DOL 5 shows restricted diffusion in the basal ganglia (arrow) and medial temporal lobes bilaterally (double arrows). EEG performed on DOL 6 shows low-voltage background activity and lack of differentiation. Note frequent positive sharp waves (PSWs) in multifocal areas (open arrows). All patients with HIE and bilateral basal ganglia involvement have developmental delay. “Depression and lack of differentiation” EEG is indicative of severe brain insult but is nonspecific as to etiology and can be due to a wide variety of conditions including severe HIE, severe metabolic disorders, meningitis or encephalitis, cerebral hemorrhage, and IVH. A depressed and undifferentiated EEG within the first 24 h after birth that persists indicates a poor prognosis.5 PSWs in full-term infants are seen in structural cerebral lesions, including periventricular leukomalacia, intracerebral hemorrhages, HIE, and infarctions.4,23,24,26 Source: Newborn, Atlas of Pediatric EEG Citation: Laoprasert P. Atlas of Pediatric EEG; 2011 Available at: http://neurology.mhmedical.com/DownloadImage.aspx?image=/data/books/1042/lao001_fig_03-61.gif&sec=59079263&BookID=1042&ChapterSecID=59078725&imagename= Accessed: October 20, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved