Affiliations: Division of Pediatric Neurology, University of
Calgary, Calgary, AB, Canada | Division of Pediatric Neurology, University of
Alberta, Edmonton, AB, Canada | Division of Critical Care Medicine, University of
Calgary, Calgary, AB, Canada
Note: [] Correspondence: Dr. D. Barry Sinclair, Division of Pediatric
Neurology, University of Alberta, 11402 University Avenue, Edmonton, AB, T6G
2R7, Canada. Tel.: +1 780407 7329; Fax: +1 780407 8283; E-mail:
Barry.Sinclair@capitalhealth.ca
Abstract: Diffusion weighted imaging is currently the standard of care in the
early imaging of hypoxic-ischemic brain injury. Its use has been well described
in adults; however, there is a paucity of data regarding its use and
reliability in the immature brain. Here we report a case of a 17-month-old who
died from a diffuse hypoxic ischemic injury secondary to asphyxiation where
there was a failure of diffusion-weighted imaging to show diffuse injury. The
electroencephalogram, neurological examination and computerized tomography all
suggested global hypoxic-ischemic injury, yet the diffusion weighted imaging
showed only focal ischemia at 48 hours post injury. We discuss possible
mechanisms underlying the failure of diffusion-weighted imaging to provide an
accurate measure of the severity of this child's injury, and highlight the
importance of the neurological examination in determination of prognosis in
hypoxic-ischemic brain injury.
