Deep nuclei injury distribution in isolated "basal ganglia–thalamus" (BGT) versus combined "BGT and watershed" patterns of hypoxic–ischaemic injury (HII) in children with cerebral palsy. Issue 11 (November 2022)

• Record Type: Journal Article
• Authors: Elsingergy, M.M.; Worede, F.; Venkatakrishna, S.; Andronikou, S.
• Is Part Of: Clinical radiology. Volume 77:Issue 11(2022)
• Page Start: 825
• Page End: 832
• Publication Date: 2022-11
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2022.04.019
• Languages: English
• ISSNs: 0009-9260

Abstract

Abstract : AIM: To compare frequency and distribution of deep nuclei involvement in isolated basal ganglia and ventrolateral thalamus (BGT) versus combined BGT and watershed (BGT-WS) hypoxic–ischaemic injury (HII). MATERIALS AND METHODS: A retrospective review was undertaken of the magnetic resonance imaging (MRI) reports of children (0–18 years) with isolated BGT or combined BGT-WS HII. The location and extent of deep nuclear injuries were compared between groups using Fisher's exact test. Results: Of 762 MRI reports, 435 (57%) had isolated BGT and 327 (43%) combined BGT-WS. Isolated BGT showed basal ganglia involvement in 85.1% ( n= 370) versus 49.8% ( n= 163) for combined BGT-WS ( p< 0.01). Sole putamen lesions were more common in isolated BGT (70.3%; 306) versus combined (19.3%; 63; p< 0.01). Thalamic involvement was similar between isolated BGT (93.8%; 408) and combined BGT-WS (96.9%; 317; p> 0.05). Sole ventrolateral nucleus involvement was more common in isolated BGT (66.6%; 291) while sole pulvinar lesions (25.1%; 82) and whole thalamus lesions (41.6%; 136) were more common in combined BGT-WS ( p< 0.01). Putamen and ventrolateral nucleus was the most frequent BGT lesion combination in isolated BGT (55.4%) but not in combined BGT-WS (8.6%; p< 0.01). CONCLUSION: Variations in the frequency of deep nuclear lesions between groups may reflect different underlying pathogenetic mechanisms. Therefore, combined BGT-WS patterns may not necessarily indicate a superimposed profound on partial prolonged HII, as other causes such as neonatal hypoglycaemia may cause these. Highlights: BGT-WS MRI pattern may not always be due to superimposed patterns of HII. Multiple potential mechanisms could lead to BGT-WS MRI pattern. BGT-WS lesions can occur in alternative pathologies accompanying WS insults. Delayed thalamocortical degeneration by primary injury can lead to BGT-WS lesion. Medicolegal implcations of BGT pattern of injury can vary based on sentinel events.