Voit T, Lemburg P, Neuen E, Lumenta C, Stork W
Department of Pediatrics, University of Düsseldorf, FRG.
Neuropediatrics. 1987 Aug;18(3):176-81. doi: 10.1055/s-2008-1052475.
Thalamic-striatal damage of symmetric bilateral distribution was found in four severely asphyxiated neonates born at term. Two patients showed evidence of bilateral thalamic-striatal necrosis and two showed hemorrhage of the same distribution. The four patients had a common history of prolonged asphyxia in the neonatal period combined with severe acidosis and respiratory insufficiency. The outcome was lethal in all children. Three patients survived for some time and showed additional evidence of generalized brain damage including cortical necrosis and subcortical leucomalacia and one patient was found to have intravital calcification of the putamen at 14 days of age. The appearance of thalamic-striatal damage in US, CCT and NMR imaging is discussed. Thalamic-striatal damage may not be detectable by US until several days after the initial insult. US does not permit a distinction between necrosis and hemorrhage, but CCT and NMR imaging may be successful. Only five infants with a comparable pattern of brain damage due to asphyxia have been described so far. Our own studies seem to indicate that thalamic-striatal damage is the hallmark of more widespread brain damage, and that it will be found more frequently if carefully looked for in asphyxiated neonates born at term.
在4例足月出生的重度窒息新生儿中发现了对称性双侧丘脑纹状体损伤。2例患者显示双侧丘脑纹状体坏死，2例显示相同分布的出血。这4例患者有新生儿期长时间窒息合并严重酸中毒和呼吸功能不全的共同病史。所有患儿预后均为致死性。3例患者存活了一段时间，还显示出包括皮质坏死和皮质下白质软化在内的广泛性脑损伤的其他证据，1例患者在14日龄时发现壳核活体钙化。讨论了丘脑纹状体损伤在美国超声（US）、计算机断层扫描（CCT）和核磁共振成像（NMR）中的表现。在最初损伤后数天内，US可能无法检测到丘脑纹状体损伤。US无法区分坏死和出血，但CCT和NMR成像可能可以做到。迄今为止，仅描述了5例因窒息导致类似脑损伤模式的婴儿。我们自己的研究似乎表明，丘脑纹状体损伤是更广泛脑损伤的标志，并且如果在足月出生的窒息新生儿中仔细寻找，将会更频繁地发现。
