Purpose or Case Report: Hypoxic-ischemic encephalopathy is a potentially devastating neurological diagnosis for which prompt recognition is crucial for patient management. The appearance of HIE on imaging depends on the duration and severity of the hypoperfusion injury, which can range from global to subtle. As such, the differential diagnosis is wide, including infectious, metabolic, and congenital dysmyelination causes. It is also critical for the pediatric radiologist to be aware of possible confounding cases when presented with imaging features seen in HIE which would significantly change management.
Methods & Materials: A retrospective analysis of multimodality imaging in neonatal patients demonstrating imaging features similar to that of HIE with alternative diagnoses, who presented to an urban children’s hospital since 2005 is performed. Imaging and clinical history are correlated with laboratory findings where applicable. A variety of HIE mimics are selected for imaging review.
Results: Review of mimics of HIE is provided with imaging examples. Examples include infectious, metabolic, and other disorders, including, but not limited to herpes infection, parechovirus infection, non-ketotic hyperglycemia, neonatal hypoglycemia, and disorders of myelination.
Conclusions: While HIE in itself is a crucial diagnosis to make, it is important for the pediatric radiologist to be familiar with the differential diagnoses that can mimic the findings of HIE, many of which require prompt recognition to improve patient outcomes.