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PT  - JOURNAL ARTICLE
AU  - Misser, S.K.
AU  - Lotz, J.W.
AU  - van Toorn, R.
AU  - Mchunu, N.
AU  - Archary, M.
AU  - Barkovich, A.J.
TI  - Thalamus L-Sign: A Potential Biomarker of Neonatal Partial, Prolonged Hypoxic-Ischemic Brain Injury or Hypoglycemic Encephalopathy?
AID  - 10.3174/ajnr.A7511
DP  - 2022 Jun 01
TA  - American Journal of Neuroradiology
PG  - 919--925
VI  - 43
IP  - 6
4099  - http://www.ajnr.org/content/43/6/919.short
4100  - http://www.ajnr.org/content/43/6/919.full
SO  - Am. J. Neuroradiol.2022 Jun 01; 43
AB  - BACKGROUND AND PURPOSE: Considerable overlap exists in the MR imaging features of hypoglycemic injury and hypoxic-ischemic brain injury, with similar predilections for the occipital and parietal lobes. In partial, prolonged hypoxia-ischemia, there is cortical destruction at the interarterial watershed zones, and in concomitant hypoglycemia and hypoxia-ischemia, an exaggerated final common pathway injury occurs. We interrogated secondary white matter tract–based thalamic injury as a tool to separate pure injuries in each group.MATERIALS AND METHODS: A retrospective observational study of the MRIs of 320 children with a history of hypoxia-ischemia and/or hypoglycemia was undertaken with 3 major subgroups: 1) watershed-type hypoxic-ischemic injury, 2) neonatal hypoglycemia, and 3) both perinatal hypoxia-ischemia and proved hypoglycemia. Cerebral and thalamic injuries were assessed, particularly hyperintensity of the posterolateral margin of the thalami. A modified Poisson regression model was used to assess factors associated with such thalamic injury.RESULTS: Parieto-occipital injuries occurred commonly in patients with hypoglycemia and/or hypoxia-ischemia. Eighty-five of 99 (86%) patients with partial, prolonged hypoxia-ischemia exhibited the thalamus L-sign. This sign was also observed in patients who had both hypoglycemia and hypoxia-ischemia, predominantly attributable to the latter. Notably, the risk of a thalamus L-sign injury was 2.79 times higher when both the parietal and occipital lobes were injured compared with when they were not involved (95% CI, 1.25–6.23; P = .012). The thalamus L-sign was not depicted in patients with pure hypoglycemia.CONCLUSIONS: We propose the thalamus L-sign as a biomarker of partial, prolonged hypoxia-ischemia, which is exaggerated in combined hypoglycemic/hypoxic-ischemic injury.HGIhypoglycemic injuryHIBIhypoxic-ischemic brain injury