Fig. 1.

A representative case in the early group (a, b) and the later group (c, d). a, b The infant was born at 39⁺⁵ weeks. Birth weight was 3,200 g. Delivery was complicated by uterine rupture. Apgar score was 0 at 1 min and 0 at 5 min. Sarnat grade 3 and aEEG showed a flat trace. MRI was performed on day 2 and showed a “near-total” pattern of injury. Restricted diffusion was most marked in the thalami (apparent diffusion coefficient [ADC] value was 543 × 10^–6 mm²/s), but was also present in the subcortical white matter, central sulcus, posterior limb of internal capsule, hippocampus, and peduncles (a). Restricted diffusion was not clearly seen in the basal ganglia; however, the mean ADC values were decreased (808 × 10^–6 mm²/s) (b). The infant died following redirection of care. c, d The infant was born at 40⁺¹ weeks. Birth weight was 4,200 g. Delivery was complicated by uterine rupture. Apgar score was 2 at 1 min and 4 at 5 min. Sarnat grade 2 and aEEG showed a burst suppression pattern. MRI was performed on day 4. The MRI showed a basal ganglia and thalamus pattern of injury. Focal areas of restricted diffusion are seen in the ventrolateral nuclei of thalami, posterior parts of basal ganglia, and cerebral peduncles (c). The mean ADC values were 861 × 10^–6 mm²/s in the basal ganglia and 808 × 10^–6 mm²/s in the thalamus (d).