Non-perinatal hypoxic ischemic encephalopathy – Long term outcome and clinico-radiological correlation

Abstract

Objective

To study the long-term outcome of non-perinatal Hypoxic Ischemic Encephalopathy (HIE) and to co-relate clinical outcomes with neuroimaging findings.

Materials and Methods

Retrospective chart review and telephonic follow up study.

Family members of 72 patients, out of 101 screened patients (admitted to an inpatient rehabilitation facility with diagnosis of “HIE” within 6 months of hypoxic insult) were contactable and current telephonic modified Rankin Scale (mRS) was documented. mRS of 0–3 was considered as favorable clinical outcome and mRS of 4–6 as poor outcome. Neuroimaging (CT and MRI) were reviewed by a neuro-radiologist.

Results

The mean (SD) age was 34.06 (18.33) years. One year survival rate was 84.7 % (61/72 patients), with severe disability (mRS 5) in 78.6 % (n = 48) of survivors. At follow up, 60 patients (83.3 %) had poor outcome (mRS 6, 38.9 %, n = 28; mRS 5, 31.9 %, n = 23; mRS 4, 12.5 %, n = 9) and 12 patients (16.7 %) had favorable clinical outcome (mRS 2 and 3). Patients with favorable outcomes had normal imaging or subcortical involvement without diffusion restriction. Diffuse cortical and deep grey involvement, diffuse cortical white matter involvement, cerebellar involvement and brain stem involvement had worse prognosis.

Conclusion

HIE has an overall poor outcome in 83.3 % of the patients. Focal findings on MRI may have a slightly better prognosis than diffuse findings.