Related Experiment Video
Updated: May 12, 2026
08:47
The Hypoxic Ischemic Encephalopathy Model of Perinatal Ischemia
Published on: November 19, 2008
35.9K
Hypoxic-ischaemic encephalopathy, perinatal stroke or both? A case report
Adilah W Ab Rahim1,2, Assyifaa Bt Nik Mazian2,3, Halimah Binti Abdul Halim1,2
1Paediatric Unit, Universiti Sains Islam Malaysia, Nilai, Malaysia.
Journal of Neonatal-Perinatal Medicine
|September 3, 2025
Summary
Perinatal stroke can mimic hypoxic-ischaemic encephalopathy (HIE) at birth, often presenting with seizures. This case highlights the importance of considering stroke and using MRI for accurate diagnosis and appropriate therapeutic hypothermia (TH) initiation.
Area of Science:
- Neonatal neurology
- Pediatric neurology
- Neurocritical care
Background:
- Perinatal stroke involves brain infarction or hemorrhage in newborns up to 28 days old.
- It often presents with seizures within 72 hours of birth.
- Hypoxic-ischaemic encephalopathy (HIE) typically presents with encephalopathy at birth.
Purpose of the Study:
- To present a case of perinatal stroke initially misdiagnosed as HIE.
- To discuss the diagnostic challenges and management strategies for differentiating perinatal stroke and HIE.
- To emphasize the role of advanced imaging in diagnosis.
Main Methods:
- Case report detailing a neonate with symptoms initially suggestive of HIE.
- Initiation of therapeutic hypothermia (TH) based on clinical presentation and seizure activity.
- Diagnostic Magnetic Resonance Imaging (MRI) of the brain to confirm the diagnosis.
Main Results:
- The neonate presented with poor Apgar score and metabolic acidosis, initially treated for suspected HIE.
- Focal seizures at 7 hours of life prompted TH initiation.
- Brain MRI revealed a left posterior cerebral artery territory subacute infarct with hemorrhagic component.
Conclusions:
- Perinatal stroke and HIE share similar initial presentations, complicating early diagnosis.
- Therapeutic hypothermia (TH) is a reasonable intervention given the overlapping symptoms.
- Scoring tools for MRI interpretation can aid in differentiating HIE from stroke and improving prognostication.
Keywords:
hypoxic-ischaemic encephalopathyneonatal encephalopathyperinatal stroketherapeutic hypothermiaMore Related Videos
Related Concept Videos
01:15Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
01:15Ischemic Stroke ll: Pathophysiology
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
01:19Encephalitis l: Introduction
Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...
01:26Encephalitis ll: Pathophysiology
Encephalitis is inflammation of the brain parenchyma caused by direct viral invasion or immune-mediated mechanisms triggered by infections or tumors. Both processes lead to neuronal injury, disrupted neurotransmission, and diverse neurological symptoms, often with overlapping clinical and pathological features.Autoimmune EncephalitisIn autoimmune encephalitis, antibodies target neuronal antigens on cell surfaces, synapses, or within neurons. A key example is anti-NMDAR encephalitis, which can...
01:22Cerebral Edema ll: Pathophysiology
Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...
01:29Hepatic Encephalopathy
DefinitionHepatic encephalopathy is a reversible neurologic syndrome that results from advanced liver dysfunction or portosystemic shunting. It leads to disturbances in cognition, behavior, and motor function due to the brain’s exposure to gut-derived toxins that the liver fails to detoxify.EtiologyThis condition develops either in the setting of acute fulminant hepatitis or progressively during chronic liver disease, such as cirrhosis and portal hypertension. Portosystemic shunting—including...