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Updated: May 14, 2026
The Hypoxic Ischemic Encephalopathy Model of Perinatal Ischemia
Published on: November 19, 2008
Mimickers of hypoxic-ischaemic brain injury in term neonates: What the radiologist should know
Shalendra K Misser1,2, Moherndran Archary3
1Faculty of Radiology, Lake Smith and Partners Inc., Durban, South Africa.
Insights
Neonatal hypoxic-ischaemic brain injury (HIBI) can be mistaken for other conditions. This review highlights alternative diagnoses that mimic HIBI on MRI, crucial for accurate diagnosis in infants.
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Neonatal Neurology
Background:
- Neonatal hypoxic-ischaemic brain injury (HIBI) has characteristic MRI patterns.
- However, other conditions can present with similar imaging findings, complicating diagnosis.
- Accurate differentiation is vital for appropriate management and prognosis.
Purpose of the Study:
- To review and illustrate imaging patterns of conditions that mimic HIBI in neonates.
- To aid radiologists in differentiating HIBI from alternative diagnoses.
- To improve diagnostic accuracy in neonatal encephalopathy.
Main Methods:
- Retrospective review of MRI studies in children with suspected cerebral palsy.
- Correlation of imaging findings with clinical details and laboratory tests.
- Classification of mimickers into categories: developmental, vascular, infectious, metabolic, chromosomal, and congenital syndromes.
Main Results:
- Sixty-three cases with HIBI-mimicking patterns were identified.
- Imaging features frequently resembled known HIBI patterns.
- Alternative diagnoses included a range of developmental, vascular, infectious, metabolic, chromosomal, and congenital disorders.
Conclusions:
- Several non-HIBI conditions can present with imaging features similar to HIBI.
- Awareness of these mimickers is essential for accurate clinico-radiological diagnosis in neonates.
- This pictorial essay aids in recognizing these alternative diagnoses.
Abstract:
Patterns of neonatal hypoxic-ischaemic brain injury (HIBI) are fairly well known. There are, however, other diagnoses with imaging patterns that may mimic HIBI. A review of MRI studies was conducted for children with suspected cerebral palsy, correlated with prior imaging, clinical details and laboratory tests where available. In the 63 identified cases, imaging features were, in many cases, very similar to the known patterns of HIBI. The alternative diagnoses can be classified as developmental, vascular, chromosomal, infections, metabolic disorders, and congenital syndromes. These findings are described in this pictorial essay. The potential mimickers of HIBI described in this essay can demonstrate similar imaging appearances to HIBI.
Contribution:
There are multiple possible causes of neonatal encephalopathy other than hypoxic-ischaemic encephalopathy. Many conditions may mimic HIBI, each of which can be associated with significant morbidity. It is prudent for the reporting radiologist to be aware of these alternate clinico-radiological diagnoses.
