PICTURE OF THE MONTH The Wrath of Severe Term Hypoxic-Ischemic Encephalopathy Angom Kiran Devi 1 & Chaitanya Reddy 2 & Priyanka Madaan 2 & Naveen Sankhyan 2 & Lokesh Saini 2 Received: 10 June 2019 /Accepted: 31 July 2019 # Dr. K C Chaudhuri Foundation 2019 A 5-mo-old boy presented with global developmental delay, small head-size and epileptic spasms (for the past 1 mo). He was born at term, to unrelated healthy parents by a prolonged vaginal delivery. The antenatal period was uneventful. He was born limp and cyanosed. Apgar score was 1, 1 and 3 at 0, 5 and 10 min respectively. He required resuscitation and subsequent mechanical ventilation for 2 wk in view of stage-3 hypoxic-is- chemic encephalopathy (HIE). Neuroimaging done for etiologi- cal workup revealed cystic and gliotic lesions at the classical sites affected in term HIE (Fig. 1). Electroencephalography revealed Fig. 1 Axial MRI brain sequences of the index child. Axial MRI brain-T1 sequence (a), T2 sequence (b) and FLAIR sequence (c) at the level of basal ganglia and thalamus show bilateral thalamic and right putaminal cysts (arrows). Axial MRI brain FLAIR sequences show cysts in the cerebellum (arrows in d), cysts in bilateral putamen (arrows in e), and bilateral parasagittal cortical hyperintensities (arrowheads in f) * Lokesh Saini drlokeshsaini@gmail.com 1 Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India 2 Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India The Indian Journal of Pediatrics https://doi.org/10.1007/s12098-019-03053-9