Two patterns of perinatal brain damage and their conditions of occurrence

Myers, Ronald E.

doi:10.1016/0002-9378(72)90124-x

Cited by 513 publications

(251 citation statements)

References 20 publications

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“…We are aware that this distinction appears to conflict with what has been previously demonstrated in primate models of fetal and neonatal hypoxia-ischemia by Myers. 22 That study, in fact, showed that only severe and prolonged periods of hypoxia resulted in subcortical and brain stem infarctions, resembling the watershed tegmentum lesions in neonates.…”

Section: Discussionmentioning

confidence: 92%

Dorsal Brain Stem Syndrome: MR Imaging Location of Brain Stem Tegmental Lesions in Neonates with Oral Motor Dysfunction

Quattrocchi¹,

Longo²,

Delfino³

et al. 2010

AJNR Am J Neuroradiol

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SUMMARY:The anatomic extent of brain stem damage may provide information about clinical outcome and prognosis in children with hypoxic-ischemic encephalopathy and oral motor dysfunction. The aim of this study was to retrospectively characterize the location and extent of brain stem lesions in children with oral motor dysfunction. From January 2005 to August 2009, 43 infants hospitalized at our institution were included in the study because of a history of hypoxic-ischemic events. Of this group, 14 patients showed oral motor dysfunction and brain stem tegmental lesions detected at MR imaging. MR imaging showed hypoxic-ischemic lesions in supra-and infratentorial areas. Six of 14 patients revealed only infratentorial lesions. Focal symmetric lesions of the tegmental brain stem were always present. The lesions appeared hyperintense on T2-weighted images and hypointense on IR images. We found a strong association (P Ͻ .0001) between oral motor dysfunction and infratentorial lesions on MR imaging. Oral motor dysfunction was associated with brain stem tegmental lesions in posthypoxic-ischemic infants. The MR imaging examination should be directed to the brain stem, especially when a condition of prolonged gavage feeding is necessary in infants.ABBREVIATIONS: APGAR ϭ appearance, pulse, grimace, activity, respiration; CI ϭ confidence interval; IR ϭ inversion recovery; SE ϭ spin-echo B rain MR imaging is the study of choice for assessing hypoxic-ischemic injury in neonates and infants.1,2 The pattern of brain injury suggests the pathogenetic mechanism and, together with the severity and extent of tissue damage, provides information about outcome and prognosis. Whereas conventional and advanced MR imaging protocols are appropriate for detecting supratentorial lesions, most routine MR imaging studies are not suitable for depicting brain stem hypoxic-ischemic lesions. Findings on advanced MR imaging techniques such as diffusion-weighted imaging and MR spectroscopy are difficult to interpret. In fact, to our knowledge, few reports on brain stem hypoxic-ischemic MR imaging findings in children have been reported in the literature.At the brain stem level, involvement of cranial nerve nuclei and ascending-descending tracts has important chronic and potentially life-threatening clinical consequences.Swallowing is a complex process with reflex activities that involve efferent and afferent fibers from the nuclei of cranial nerves V (cranial pons), VII, IX, X (caudal pons), and XII (medulla oblongata). The stereotypical sequence of oropharyngeal, laryngeal, and esophageal muscle contraction is elicited by stimulation of the pharynx by a food bolus and is derived from a central pattern generator. 3 The generator neurons for the sequential motor response are located in the nucleus tract solitarius and in the dorsal medullary reticular formation.The tegmentum of the brain stem corresponds to the watershed area between the paramedian and circumferential branches of the basilar artery and is known to represent a vulnerable site to ische...

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Section: Discussionmentioning

confidence: 92%

Dorsal Brain Stem Syndrome: MR Imaging Location of Brain Stem Tegmental Lesions in Neonates with Oral Motor Dysfunction

Quattrocchi¹,

Longo²,

Delfino³

et al. 2010

AJNR Am J Neuroradiol

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“…It is known that in the preterm and perinatal period the auditory pathway is indeed vulnerable to various exogenous influences, such as anoxicischemic insults, hypotension, and hypoglycemia. Furthermore, several experiments have demonstrated selective vulnerability of auditory relay nuclei, such as the cochlear nuclei, superior olives, and inferior colliculi, in this period (Dobbing and Sands, 1973;Griffiths and Laurence, 1974;Myers, 1975, Norman, 1975Leech and Alvord, 1977;Salamy etal., 1982).…”

Section: Discussionmentioning

confidence: 97%

The Effects of Early and Late Preterm Birth on Brainstem and Middle-Latency Auditory Evoked Responses in Children with Normal Neurodevelopment

Pasman

Rotteveel²,

Graaf³

et al. 1996

Journal of Clinical Neurophysiology

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“…The internal circuitry can be adjusted to accept either bipolar or unipolar input signals with peak-to-peak amplitudes ranging from 2 to 10 V. Obstetric events as determined by fetal monitoring can yield indications of fetal head or brain compression which may have some direct bearing on neonatal neurological problems, and can be used in the earliest identification of aberrations in development and maturation of the infant. The experimental data imply that poor fetal oxygenation, for example, is associated with neurologic handicap later in development (Myers, 1972). The current effort, therefore, is to conduct longitudinal studies using averaged evoked auditory and visual EEG potentials (AEPs) (peltzman, Ostwald, Yeager, & Manchester, 1970) with monitored normal infants and infants who showed fetal stress, in order to ascertain early sensory sequelae and attempt to relate these measurements to the intrauterine data.…”

Section: Kmentioning

confidence: 99%

“…The continuous and simultaneous recording of the fetal electroencephalogram to determine drug effect on the fetal brain (peltzman, Goldstein, & Battagin, 1973a, b) using fetal scalp bipolar screw electrodes (peltzman, Goldstein, Battagin, & Markevitch, 1973) is currently considered to be a research tool, but one which holds promise as another useful adjunct to clinical decision making. The goal is to reduce perinatal mortality, improve the quality of survivors, and provide a basis for early management of newborn brain damage (Myers, 1972).…”

mentioning

confidence: 99%