Severe outcome of brain perfusion failure: a pre-hydranencephalic state?

Four children surviving severe hypoxic-ischemic brain damage showed subtotal destruction of the cerebral hemispheres, with partial preservation of some infratentorial and supratentorial brain structures. True multicystic encephalopathy features were identified in two cases on CT scanning. The other patients showed more pronounced brain tissue destruction, with overall malacia of the hemispheres. An echographic study demonstrated that the brain damage occurred progressively, within about one month, and was preceded by oedema, white matter malacia and cavitation. The role of the compensatory mechanisms responsible for preservation of structures supplied by the vertebral-basilar circle is discussed. The authors suggest that the observed outcome could be considered a stage immediately preceding the most severe damage represented by hydranencephaly.