"The MRI Says Basal Ganglia": Reading Your Baby's MRI and EEG Results
After cooling for HIE, most babies have an MRI in the first week and an EEG during and after cooling. The MRI shows which parts of the brain were affected, and the pattern helps doctors estimate both your baby's risks and when the injury most likely happened. Sydney's Royal Hospital for Women recommends the MRI between days 4 and 7. This guide explains the words on the report, what the EEG terms mean, what the results can and can't tell you, the questions to ask at the results meeting, and how to get copies of the scans.
An MRI is usually done in the first week after birth, once rewarming is finished. It shows which areas of the brain were affected, such as the basal ganglia and thalamus or the watershed areas, and the pattern helps predict risks and estimate when the injury happened. But the MRI and the baby don't always match, in either direction, and no scan can tell you for certain how your child will grow up.
Reading the MRI report
Which word is on your baby's report? Tap an area of the brain.
Simplified drawing, not to scale
Basal ganglia
What it does
Deep clusters of nerve cells near the centre of the brain that help control movement, posture and muscle tone, including the fine coordination needed to suck, swallow and later speak.
On an HIE scan
Injury here usually comes with injury to the thalamus. Doctors call it the basal ganglia–thalamus pattern. It is most often seen after a sudden, severe event such as a uterine rupture, placental abruption or cord prolapse, and carries a higher risk of movement problems, including cerebral palsy. How much is affected varies a great deal.
Thalamus
What it does
A relay station that passes signals for sensation and movement between the body and the outer brain. There is one on each side ("thalami").
On an HIE scan
The thalamus is one of the most active parts of a newborn's brain, which makes it vulnerable when oxygen is cut off suddenly. It is usually reported together with the basal ganglia.
Posterior limb of the internal capsule (PLIC)
What it does
A narrow bundle of nerve fibres that carries movement signals from the brain down to the body. At term it is one of the few areas already coated in myelin, so it shows up clearly on the scan.
On an HIE scan
Doctors look closely at whether the PLIC looks normal. An abnormal signal here is one of the stronger warning signs for later movement problems. A normal PLIC is generally reassuring, but it is never a guarantee on its own.
White matter
What it does
The brain's wiring: the nerve fibres that connect different areas so they can work together.
On an HIE scan
White matter injury may be described as "signal change", "restricted diffusion" or "white matter injury". It is often part of the watershed pattern. A diffusion scan (DWI) taken early is good at picking it up.
Watershed areas
What they are
The border zones between the brain's main blood supplies, towards the front and back on each side. They are the last areas to be reached by blood, a bit like the end of a garden hose.
On an HIE scan
Injury here, called the watershed pattern, is linked with a longer period of reduced oxygen or blood flow rather than one sudden event. Severe movement problems are less common, and many babies look well at 12 to 18 months. Language delay, behavioural difficulties and slower head growth may show up later, so follow-up matters.
Cortex
What it does
The folded outer layer of the brain, responsible for thinking, sensing, planning movement, vision and language.
On an HIE scan
The cortex can be involved in more severe injury of either pattern. A strip of cortex that controls movement (the "perirolandic" or "central" cortex) is often affected along with the basal ganglia and thalamus.
A simplified guide drawn from the Royal Hospital for Women HIE guideline and published research. Every scan is different: ask your baby's neonatologist or neurologist to show you the pictures and explain your baby's own report.
"They told us the MRI would be 'later in the week'. It was ten days. Ten days of asking every nurse, every shift, 'Is it today?'
When it was finally done, nobody came. Then on the ward round the next morning, a doctor I'd never met said to the group, standing at the end of the cot, 'and the MRI shows basal ganglia changes', and moved on to the next baby.
I didn't know what the basal ganglia were. I didn't know if 'changes' meant a little or a lot. I sat in the parents' room and looked it up on my phone, and the first thing that came up said 'severe disability'. My husband found me there an hour later. I hadn't moved."
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
If you are waiting for the MRI, or have just heard a word from the report you don't understand, I'm sorry. The days around the scan are some of the hardest in the whole HIE journey. Parents tell me the waiting is bad, but hearing the result badly is worse.
This guide is here so that the words on the report make sense before, or after, someone explains them to you properly. Tap the diagram above to see where each area is. Then read on for what the scan can tell you, what it can't, and what to ask.
I am a medical negligence lawyer, not a doctor. I have practised since 2013 and worked on many hundreds of claims, including for families after injuries at birth, and reading MRI and EEG reports alongside the experts is part of that work. My doctoral research looked at patterns of failure in medical negligence. Everything clinical here is drawn from, and checked against, the guidelines and research listed at the end. Your baby's own team is the right source for anything about your baby.
The scans, and when they happen
MRI (magnetic resonance imaging) · A scan that uses a strong magnet and radio waves, not radiation, to make detailed pictures of the brain in thin slices. For HIE it usually includes diffusion-weighted imaging (DWI), which picks up recently injured tissue, and sometimes MR spectroscopy (MRS), which measures chemicals in the brain.
In plain terms: a very detailed photo of your baby's brain, taken in slices, that shows where any injury is and roughly how widespread it is.
The Royal Hospital for Women in Sydney says in its HIE guideline (revised July 2024) that cooled babies should have an MRI with diffusion imaging, with or without spectroscopy, between 4 and 7 days of life. It calls MRI "the most sensitive and specific imaging" for HIE. Many units do it as a "feed and wrap" scan: your baby is fed, swaddled and scanned asleep, without a general anaesthetic. Queensland's HIE guideline takes a similar approach. In practice, as Mia found, the scan may be later than planned, especially if your baby was transferred or is still unwell.
EEG and aEEG · An EEG (electroencephalogram) records the brain's electrical activity through small sensors on the scalp. An aEEG (amplitude-integrated EEG, sometimes called a cerebral function monitor) is a simplified version that runs continuously at the cot side.
In plain terms: the wires on your baby's head. They show how active the brain is, whether it is settling into normal patterns, and whether there are seizures, including ones you can't see.
The same guideline says the aEEG should go on at the earliest suspicion of encephalopathy, run for the whole of cooling, and that every cooled baby should also have a formal EEG. It also says cooling should never be delayed while waiting for aEEG results.
The words on the MRI report
MRI reports are written by radiologists for other doctors, not for parents. Here are the words parents ask me about most. The diagram above shows where each area sits.
- Basal ganglia: deep clusters of nerve cells that help control movement, posture and muscle tone.
- Thalamus (thalami): a relay station for sensation and movement signals, deep in the centre of the brain.
- Posterior limb of the internal capsule (PLIC): a narrow bundle of fibres carrying movement signals down to the body. Doctors look closely at whether it looks normal.
- White matter: the brain's wiring, connecting different areas.
- Watershed areas: the border zones between the brain's main blood supplies.
- Cortex: the folded outer layer, for thinking, sensing, movement planning, vision and language.
- Restricted diffusion: an area that looks bright on the diffusion scan, meaning tissue that was recently injured.
- "Signal change" or "signal abnormality": an area that looks different from how it should. It doesn't by itself say how serious the change is.
- "Normal study": no injury could be seen. Usually very good news, though not a guarantee.
The two patterns doctors look for
Doctors don't only look at whether there is injury, but at its pattern. In a widely cited review in Neuroradiology, the Dutch neonatal neurologists Linda de Vries and Floris Groenendaal describe two main patterns in babies born at term.
The basal ganglia–thalamus pattern
Injury mainly to the deep grey matter (the basal ganglia and thalamus), often with the strip of cortex that controls movement. The review says it is most often seen after an acute "sentinel" event, such as a uterine rupture, placental abruption or cord prolapse: a sudden, severe loss of oxygen. It carries the highest risk of movement problems. The Royal Hospital for Women guideline notes that in one study, 56% of babies with this pattern went on to develop spastic quadriplegia, a form of cerebral palsy affecting all four limbs. That also means many did not.
The watershed pattern
Injury mainly to the white matter, and sometimes the cortex, in the border zones between the major blood supplies. The review links it with "prolonged partial asphyxia": a longer period of reduced oxygen or blood flow, such as over hours of labour. Severe movement problems are less common, and many children look well at 12 to 18 months. But language delay, behavioural difficulties and slower head growth may show up later. That is one reason follow-up continues to at least two years, and why "he's fine" at one may not be the whole story.
Some babies have a mix of both. Some have a normal MRI. And the posterior limb of the internal capsule has a special place in all of this: the review cites research showing that an abnormal signal there is highly predictive of serious later problems with movement.
"Our MRI was the bad one. The neurologist used the word 'extensive'. She was kind, and she was honest, and she said she couldn't promise us anything.
At three months, Leo was feeding from a bottle. He was following my face across the room. He smiled at his sister. The physio at follow-up said, 'I wouldn't have matched this baby to that scan.'
I'm not telling you this because it means your baby will be the same. Leo has a long road, and we don't know yet where it goes. I'm telling you because nobody told me that a scan is a picture of one week, and your baby is a whole person who keeps growing after it."
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
What the MRI can't tell you
The Royal Hospital for Women guideline is unusually frank about this. It says prognosis in HIE is "extremely unpredictable", partly because of the plasticity of a baby's brain, and tells its doctors to "avoid certainty in prognostication". It also says babies with moderate to severe HIE remain at a 30 to 70% risk of death or disability even after cooling. That is a wide range, and it is wide for a reason.
So the MRI is the best single picture available, and it matters. But it is not a forecast of your child's life. A clear scan is usually very good news and still not a guarantee. A worrying scan raises the risk of problems and still doesn't tell you which problems, how severe, or what your child will be able to do. That is why your baby will be followed up for at least two years, and why my guide to living with "wait and see" exists.
The words on the EEG
The EEG is often reported in a different language again. These are the terms in the Royal Hospital for Women guideline, and what they mean.
- Background: the brain's overall pattern of activity. A "normal" or "continuous normal voltage" background is good.
- Discontinuous: the activity comes and goes rather than being continuous. Common in the first hours, and often improves.
- Burst suppression: short bursts of activity separated by long flat periods. A sign of a significantly affected brain at that moment.
- Low voltage or flat trace: very little activity. The guideline says burst suppression, low voltage and a flat trace most accurately predicted long-term outcome.
- Sleep-wake cycling: the brain moving between sleep and wake patterns, like a healthy newborn's. The guideline calls it "a good sign of a healthy brain".
- Subclinical (electrographic) seizures: seizures that show on the EEG but not in how your baby looks.
Some numbers that help. Seizures happen in about half of babies with HIE who are cooled (45 to 55%, according to the guideline), and up to half of those seizures can't be seen without the monitor. Medicines such as phenobarbital can make the aEEG look quieter for a while. Timing matters too: a background that returns to normal within 48 hours is a good sign, while one that stays abnormal at 48 hours or later is linked with a high risk of later problems. A normal aEEG at six hours is reassuring but, the guideline says, doesn't rule out a poor outcome.
What comes after the scan
Every cooled baby at the Royal Hospital for Women is followed up in a growth and development clinic until at least two years of age, and most units do the same. Increasingly, that follow-up also means looking for early signs of cerebral palsy, rather than waiting.
Research led by Australian cerebral palsy researcher Iona Novak, published in JAMA Pediatrics in 2017, found that cerebral palsy, or a high risk of it, can be accurately predicted before six months' corrected age. Before five months, the three most predictive tools are the MRI, a video assessment of your baby's spontaneous movements (the General Movements Assessment), and a structured neurological check (the Hammersmith Infant Neurological Examination, or HINE). So the MRI is one piece of a bigger picture, and it is reasonable to ask whether your baby will have the other two. Cerebral Palsy Alliance runs a free early diagnosis clinic for babies up to 12 months' corrected age. My guide to early signs, milestones and a cerebral palsy diagnosis explains more, and my guide to early intervention after HIE covers getting therapy started.
The results meeting: what good looks like
What Mia got, a word at the end of the cot on a ward round, is not how it is supposed to go. The Royal Hospital for Women guideline draws on research with parents about how they want to hear results. It recommends:
- face-to-face meetings with clear, compassionate and transparent communication
- simple, everyday language
- honest discussion of uncertainty
- prompting parents to ask questions, and giving them time to understand
- on MRI day, showing parents the pictures, or drawing the injury
You can ask for all of that. If the result was given to you badly, you can ask for a proper meeting now, even weeks later.
Questions for the results meeting · copy these into your phone
1. Can you show us the pictures and point to the areas you're describing? 2. Which pattern is this: basal ganglia and thalamus, watershed, mixed, or something else? 3. Does the posterior limb of the internal capsule look normal? 4. Was spectroscopy (MRS) done? What did it show? 5. What did the EEG show, and how quickly did the background recover? 6. Were there seizures? Seen, or only on the EEG? 7. What does this change about the risks for our baby? What doesn't it change? 8. Will our baby have a General Movements Assessment and a HINE, and when? 9. Who will follow our baby up, and who do we call with questions? 10. Can we have copies of the MRI and EEG reports, and the images?
Take someone with you if you can, and ask if you can record the meeting. You will not remember it all, and that is normal.
Getting copies of the report and the images
You are entitled to ask for your baby's health information, including the written MRI and EEG reports and the images themselves. Ask the hospital's medical records or health information unit for:
- the MRI report and the full set of images (usually on a disc or by secure download), including any cranial ultrasound
- the formal EEG report, and the aEEG record if it was kept
- any MRI or EEG scoring done
- the neonatal discharge summary
Our guide to getting and reading your birth records explains how to make the request. Keep the images safe. They are part of your child's medical history, and future doctors may want to compare them with later scans.
Why the scan matters if you want to know what happened
For families who later want to understand whether something went wrong, the MRI is one of the most important pieces of evidence there is.
In a medical negligence claim, it isn't enough to show that care fell below the standard. Under section 5D of the NSW Civil Liability Act 2002, you also have to show that it caused the harm. In HIE cases, that question often turns on when the injury happened, and the MRI pattern is central to answering it. A basal ganglia–thalamus pattern points towards a sudden, severe event, so the questions become whether that event was foreseeable and whether your baby could have been born sooner. A watershed pattern points towards a longer period of reduced oxygen, so the questions become whether a heart rate trace showed signs of distress for hours and nobody acted. The scan is also the best evidence of what your child's injury is.
That is why independent experts, usually a paediatric neuroradiologist and a paediatric neurologist, look at the images themselves rather than relying on the written report. It's another reason to get copies early. My guides to whether your baby's HIE could have been prevented and getting the records and finding out what happened go into this in detail.
"We asked for a proper meeting in the end. The consultant brought the scan up on a big screen and showed us exactly where the bright spots were. She drew it on a piece of paper for me. I still have that piece of paper.
She said the pattern looked like something sudden, not something slow. I didn't understand why that mattered until much later, when we got the records and saw what the heart rate had been doing in the hour before the caesarean.
But that day, what I needed was someone to sit down, point at the screen and say, 'This is what we know, and this is what we don't.' It should have happened the first time."
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
In my practice
When families bring me their records, the MRI report is often the document they have read the most and understood the least. Many have only ever seen the "impression" paragraph at the bottom. Some have never seen the images at all.
Two things come up again and again. First, the report and the images can tell slightly different stories, and expert radiologists don't always agree with the first report. Second, the MRI rarely answers the question parents most want answered, which is why. On its own, it describes the injury. Together with the heart rate trace, the cord gases and the timeline of the first hours, it can start to explain how the injury came about. My doctoral research was about how harm in health care usually comes from a chain of events, and the MRI is often where that chain becomes visible.
Both/and: the scan matters, and it isn't your child
Both things are true. The MRI is the most important early information doctors have about your baby's brain, and it is worth understanding every word of it. And it is a picture of one week of your baby's life, read by people who will tell you honestly that they can't predict what your child will do. You can take the scan seriously and still let your baby show you who they are.
The bigger picture
Ten years ago, many parents of babies with HIE were told to wait until 18 months or two years to learn whether their child had cerebral palsy. Australian research changed that. Research led by Iona Novak and published in JAMA Pediatrics showed that combining the MRI with the General Movements Assessment and the HINE can identify most babies at high risk before six months, when the brain is most able to respond to therapy. The way results are shared is changing too: guidelines such as the Royal Hospital for Women's now build in what parents have said they need. If your experience fell short of that, it is worth saying so to the hospital, because that is how practice improves. Our birth injury map shows where HIE sits among the other injuries that can happen at birth.
Support
- Miracle Babies Foundation: NurtureLine 1300 622 243, 24 hours, for families of sick and premature newborns.
- Life's Little Treasures Foundation: information and NICU Connections groups.
- Cerebral Palsy Alliance: the early diagnosis clinic and family information, 1300 888 378.
- PANDA (Perinatal Anxiety & Depression Australia): 1300 726 306, or panda.org.au.
- Birth Trauma Australia: birthtrauma.org.au.
- Our guide to finding support after birth trauma.
Mia still has the piece of paper the consultant drew on. It's in the folder with the discharge summary, the first family photo and the hospital bracelet that's far too small now. "It's not a nice drawing," she told me. "But it was the first time anyone made it make sense." I hope this guide does a little of that for you, and that whoever explains your baby's scan takes the time to draw it for you too. You can, and should, ask them to.
With care,
Rosemary
Back to the guide: HIE after birth: a guide for parents
Frequently asked questions
What does a basal ganglia injury mean for my baby?
The basal ganglia help control movement and muscle tone. Injury there, usually with the thalamus, raises the risk of movement problems including cerebral palsy, but how much is affected varies a lot. Your baby's neurologist can explain what your baby's scan shows.
When is the MRI done after cooling?
Usually in the first week after rewarming. The Royal Hospital for Women guideline recommends between days 4 and 7 of life, often as a "feed and wrap" scan without a general anaesthetic.
Is a clear MRI a guarantee my baby will be okay?
A normal MRI is usually very good news, but it is not a guarantee. Some effects of HIE, such as language or learning difficulties, only show as a child grows, which is why follow-up continues to at least two years.
What is burst suppression on an EEG?
Burst suppression means short bursts of brain activity separated by long flat periods. It shows the brain was significantly affected at the time of the recording. How quickly the background recovers, especially within 48 hours, matters a great deal.
Can I get a copy of my baby's MRI scan?
Yes. You can ask the hospital's medical records or health information unit for the written report and the images, usually on a disc or by secure download. Keep them safe for future doctors.
Can the MRI show when the injury happened?
It can help. A basal ganglia–thalamus pattern usually points to a sudden, severe event, and a watershed pattern to a longer period of reduced oxygen. Experts combine the MRI with the heart rate trace, cord gases and the timeline to estimate timing.
Questions about your baby's care?
When you're ready, and not before, we can talk through what happened and look at the records and scans with you, confidentially. There's no cost to find out where you stand.
Free case review Contact- HIE after birth: a guide for parents (hub)
- "It was five days before I held her": the first week in NICU
- "Moderate, then mild after the MRI": what the grade means
- "My baby wasn't cooled"
- "The MRI says basal ganglia": reading the results (you are here)
- "Still on the NG tube": feeding after HIE
- "Wait and see": the first two years
- "Tucked thumbs, head lag, stiff legs"
- Early intervention and the NDIS
- "Why didn't they do a caesarean sooner?"
- "The notes don't match what I saw"
- "They said there's no case because he's fine"
- "How long do we have?"
- "I keep replaying the birth"
- Pregnancy after HIE
- "I'm a nurse and I'd never heard of HIE"
More on birth injuries: birth trauma and obstetric negligence · time limits in NSW
References
- Royal Hospital for Women, South Eastern Sydney LHD. Hypoxic-Ischaemic Encephalopathy (HIE) in Infants ≥35 Weeks Gestation, CLIN070, revision 3, July 2024. seslhd.health.nsw.gov.au
- Queensland Clinical Guidelines. Hypoxic-ischaemic encephalopathy (HIE), July 2026. health.qld.gov.au
- NSW Agency for Clinical Innovation. Hypoxic ischaemic encephalopathy in newborns: recognition, monitoring and early management, June 2024. aci.health.nsw.gov.au
- de Vries LS, Groenendaal F. Patterns of neonatal hypoxic–ischaemic brain injury. Neuroradiology 2010;52(6):555–566. PubMed Central
- Novak I, Morgan C, Adde L, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatrics 2017;171(9):897–907. PubMed Central
- Cerebral Palsy Alliance. Early Diagnosis Clinic for Cerebral Palsy. cerebralpalsy.org.au
- Civil Liability Act 2002 (NSW), s 5D. legislation.nsw.gov.au
Stories in this article are composites drawn from many families' experiences and have been changed so that no one can be identified. They do not describe any individual client.
Written by Dr Rosemary Listing, PhD (Law). Rosemary is a medical negligence lawyer and Of Counsel at Peter Evans & Associates. She has practised since 2013 and worked on many hundreds of claims, including for families after injuries at birth. Her doctoral research examined patterns of failure in medical negligence, and she is a Sessional Lecturer in Health Law at the University of Newcastle. She is responsible for all content published under her name.
Rosemary is not medically qualified. Clinical information in this article is drawn from, and checked against, the Australian neonatal guidelines and the research listed in the references. Legal information reflects the law as at the review date.
Last updated 28 October 2026. First published 28 October 2026. Next review April 2027.
Cite this article: Listing, R. (2026, October 28). "The MRI Says Basal Ganglia": Reading Your Baby's MRI and EEG Results. Reframe Legal. https://reframelegal.com/hie-mri-eeg-results-explained/
This article is general information only. It isn't medical or legal advice about your situation, and reading it doesn't create a lawyer and client relationship. If you are worried about your baby, speak to your baby's medical team. If you are in crisis, call 000 or Lifeline on 13 11 14. Legal services are provided by Peter Evans & Associates.
