Brain lesions in preterms: origin, consequences and compensation

Abstract

Twenty‐nine high‐risk preterm born children, from a cohort with cerebral blood flow (CBF) measurements in the first 2 d of life, were examined prospectively at the age of 5.5—7 y neurologically, neuropsychologically and by magnetic resonance imaging (MRI). They were compared to 57 control children in terms of neurology and neuropsychology. Abnormal MRI was found in 19 children. Low oxygen delivery to the brain was found in 63% of them, in contrast to 12.5% in those with normal MRI, indicating neonatal hypoxia‐ischemia as an important factor. The MRI abnormalities were mainly periventricular lesions (n = 19), especially periventricular leucomalacia (PVL, n = 17). Three of the very preterm children had severe cerebellar atrophy in addition to relatively mild periventricular abnormalities. MRI showed specific morphological correlates for the major disabilities, e.g. spastic CP (involvement of motor tracts), mental retardation (bilateral extensive white matter reduction or cerebellar atrophy) and severe visual impairment (severe optic radiation involvement). A morphological correlate for minor disabilities, i.e. functional variations in motor performance or intelligence, was not found, with the exception that symptoms of attention deficit hyperactivity disorder were related to mild MRI abnormalities. This could mean that with respect to cognitive functions, mild or unilateral periventricular MRI lesions could be compensated. However, as among preterms without mental retardation (n = 19), IQ was generally and significantly lower than in the control group; other, more chronic pathogenetic factors, not detectable by MRI alone, may play a role. □Attention deficit hyperactivity disorder, cerebral blood flow, cerebral palsy, magnetic resonance imaging, oxygen delivery, periventricular leucomalacia, prematurity

The Cerebellar Development in Chinese Children—A Study by Voxel-Based Volume Measurement of Reconstructed 3D MRI Scan

“…The previous literature of studies of the cerebellum clarified relationships between structural brain volume alterations and symptoms in various regions (1)(2)(3)(4). Furthermore, based on a report by Krägeloh-Mann et al (5), marked cerebellar atrophy in preterm babies was considered to be related to severe developmental delays. Thus, cerebellar atrophy was shown to be a bad prognostic factor of motor and cognitive outcomes in children.…”

Development of Cerebral Blood Flow Volume in Preterm Neonates during the First Two Weeks of Life

“…The data presented here may serve as the basis for further studies to investigate whether deviations from this adaptive response are associated with an increased risk of brain injury. The pathogenesis of the most common causes of disabling brain injury in preterm infants is likely to be associated with abnormalities of cerebral perfusion in the first days of life (1)(2)(3). Cerebral ischemia is thought to be one of the contributing factors in the pathogenesis of periventricular brain injury in preterms (4).…”

Unusual Case of ‘Trapped Fourth Ventricle’ in a Child with Posthemorrhagic Hydrocephalus – Lessons Learnt

“…Associated posterior fossa abnormalities include severe reduction of cerebellar volume and a consequent enlarged fourth ventricle [3,4,5,6,7,8,9]. The clinical significance of this pathological entity, however, may remain unclear in a particular child with neurological worsening.…”