Intracranial infection can mimic hypoxic injury.(Obstetrics)

CABO SAN LUCAS, MEXICO -- What looks like damage from hypoxic ischemic encephalopathy on neonatal brain imaging actually can be caused by intracranial infection, Robert A. Zimmerman, M.D., said during a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.

Always correlate clinical findings and laboratory results with images of brain abnormalities to detect intracranial infections and to avoid attributing the infant's problems to hypoxic ischemic brain injury, said Dr. Zimmerman, who is the chief of pediatric neuroradiology at Children's Hospital of Philadelphia.

Dr. Zimmerman described several intracranial infections that could be confused with hypoxic ischemic encephalopathy:

* Acute cytomegalovirus infection, the most common intracranial infection that occurs in utero, causes fetal brain abnormalities in the second and third trimesters. Edema in the brain seen on imaging shortly after birth may simulate a toxic ischemic brain injury.

"The clinical work-up of the patient turns out to be critical" to differentiate the two, he said during the conference, which was sponsored by Boston University and the Center for Human Genetics.

* Neonatal meningitis may result from exposure to a pathogen in utero, at the time of delivery, or in the neonatal nursery. Both gram-negative and gram-positive bacterial meningitis can be a problem, since neonates lack a functional immune system to resist CNS infection.

Severe brain swelling secondary to E. coli meningitis infection can look like severe brain swelling from hypoxic ischemic brain injury, Dr. Zimmerman said.