Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Feb 28, 2016; 8(2): 117-123
Published online Feb 28, 2016. doi: 10.4329/wjr.v8.i2.117
Brainstem tegmental lesions in neonates with hypoxic-ischemic encephalopathy: Magnetic resonance diagnosis and clinical outcome
Carlo Cosimo Quattrocchi, Giuseppe Fariello, Daniela Longo
Carlo Cosimo Quattrocchi, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
Giuseppe Fariello, Fatebenefratelli S. Pietro Hospital, 00128 Rome, Italy
Daniela Longo, Unit of Neuroradiology, Bambino Gesù Children’s Research Hospital IRCCS, 00128 Rome, Italy
Author contributions: Quattrocchi CC conceived and designed the study and wrote the manuscript; Fariello G critically revised the manuscript for important intellectual content; Longo D supervised the study, collected diagnostic images and references and critically revised the manuscript for important intellectual content.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Carlo Cosimo Quattrocchi, MD, PhD, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, via Alvaro del Portillo, 00128 Rome, Italy.
Telephone: +39-062-25411708
Received: August 31, 2015
Peer-review started: September 1, 2015
First decision: September 29, 2015
Revised: October 11, 2015
Accepted: December 9, 2015
Article in press: December 11, 2015
Published online: February 28, 2016

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 supra-tentorial 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.

Keywords: Magnetic resonance, Asphyxia, Hypoxic-ischemic encephalopathy, Tegmentum, Neonates, Brainstem

Core tip: Brainstem tegmental lesions in neonates with hypoxico-ischemic encephalopathy: Magnetic resonance diagnosis and clinical outcome.