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Brainstem tegmental lesions in neonates with hypoxicischemic encephalopathy: Magnetic resonance diagnosis and clinical outcome

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World Journal of Radiology 2016年第2期8卷 117-123页

作者： Carlo Cosimo Quattrocchi giuseppe fariello Daniela Longo Department of Medicine and Surgery Università Campus Bio-Medico di Roma Fatebenefratelli S.Pietro Hospital Unit of Neuroradiology Bambino Gesù Children’s Research Hospital IRCCS

Lesions of the brainstem have been reported in the clinical scenarios of hypoxic-ischemic encephalopathy(HIE), although the prevalence of these lesions is probably underestimated. Neuropathologic studies have demonstrated brainstem involvement in severely asphyxiated infants as an indicator of poor outcome. Among survivors to HIE, the most frequent clinical complaints that may be predicted by brainstem lesions include feeding problems, speech, language and communication problems and visual impairments. Clinical series, including vascular and metabolic etiologies, have found selective involvement of the brainstem with the demonstration of symmetric bilateral columnar lesions of the tegmentum. The role of brainstem lesions in HIE is currently a matter of debate, especially when tegmental lesions are present in the absence of supratentorial lesions. Differential diagnosis of tegmental lesions in neonates and infants include congenital metabolic syndromes and drug-related processes. Brainstem injury with the presence of supratentorial lesions is a predictor of poor outcome and high rates of mortality and morbidity. Further investigation will be conducted to identify specific sites of the brainstem that are vulnerable to hypoxic-ischemic and toxic-metabolic insults.

关键词： Magnetic resonance Asphyxia Hypoxicischemic encephalopathy Tegmentum Neonates Brainstem

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Magnetic resonance imaging differential diagnosis of brainstem lesions in children

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World Journal of Radiology 2016年第1期8卷 1-20页

作者： Carlo Cosimo Quattrocchi Yuri Errante Maria Camilla Rossi Espagnet Stefania Galassi Sabino Walter Della Sala Bruno Bernardi giuseppe fariello Daniela Longo Department of Medicine and Surgery Università Campus Bio-Medico di Roma Department of NESMOS Sant’ Andrea HospitalUniversità La Sapienza Unit of Neuroradiology Bambino Gesù Children’s Research Hospital IRCCS Fatebenefratelli S. Pietro Hospital

Differential diagnosis of brainstem lesions,either isolated or in association with cerebellar and supra-tentorial lesions,can be challenging. Knowledge of the structural organization is crucial for the differential diagnosis and establishment of prognosis of pathologies with involvement of the brainstem. Familiarity with the location of the lesions in the brainstem is essential,especially in the pediatric population. Magnetic resonance imaging(MRI) is the most sensitive and specific imaging technique for diagnosing disorders of the posterior fossa and,particularly,the brainstem. High magnetic static field MRI allows detailed visualization of the morphology,signal intensity and metabolic content of the brainstem nuclei,together with visualization of the normal development and myelination. In this pictorial essay we review the brainstem pathology in pediatric patients and consider the MR imaging patterns that may help the radiologist to differentiate among vascular,toxico-metabolic,infectiveinflammatory,degenerative and neoplastic processes. Helpful MR tips can guide the differential diagnosis: These include the location and morphology of lesions,the brainstem vascularization territories,gray and white matter distribution and tissue selective vulnerability.

关键词： Brainstem Pediatrics Differential diagnosis Neuroradiology Magnetic resonance

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