MR spectroscopy is a promising technique for the assessment of the brain in cases of perinatal hypoxic ischemic cerebral injury . The advantage of MR spectroscopy is its ability to detect any brain injury even in absence of any conventional MRI changes and to determine its severity with good correlation with the outcome which make it a diagnostic and prognostic tool. The aim of this study is to study the different imaging features of hypoxic ischemic cerebral injury on MRS and to correlate them with the condition .