Purpose: The most severe form of profound asphyxia in neonates is now known as "total brain injury," which forms part of the clinical spectrum of hypoxic-ischemic encephalopathy (HIE). Although the magnetic resonance (MR) imaging features of total brain injury remain to be determined, a widespread hyperintensity of the supratentorial brain, known as the "white cerebrum sign," has been reported in diffusion-weighted images (DWI).
Methods: We examined four neonates who developed severe profound asphyxia.
Results: In the first week of life, all neonates showed the white cerebrum sign on DWI. A follow-up of these cases over a period of 1 month revealed diffuse bilateral multicystic encephalomalacia (MCE) as well as shrinkage of the basal ganglia and thalami (BG/T). These MR findings were common to all neonates, and all the neonates had severe adverse clinical outcomes.
Conclusion: Neonates, who exhibit the white cerebrum sign on MR imaging due to profound asphyxia, develop major disabilities, and MCE with shrinkage of the BG/T suggests miserable outcomes.
Keywords: Hypoxic-ischemic injury; Multicystic encephalomalacia; Profound asphyxia; White cerebrum sign.