Sugama S, Kusano K, Ochiai Y
Department of Pediatrics, Tokyo Metropolitan Kita Medical Rehabilitation, Center for the Handicapped.
No To Hattatsu. 1995 May;27(3):211-5.
There have been many reports concerning cases with basal ganglionic and thalamic lesions due to neonatal hypoxic-ischemic encephalopathy (HIE), which are considered as a clinicopathological syndrome. But the clinical symptoms and extension of the brain damage varied from case to case. We previously reported seven cases with bilateral basal ganglionic and thalamic lesions (BBTL) due to neonatal HIE. The affected lesions were posterior putamen, lateral thalami, hippocampus and perirolandic cortex. Now, we have experienced two cases who presented symmetrical thalamic lesions (STL) with involvement of the brainstem and periventricular white matter due to neonatal HIE. Of these lesions of the basal ganglia and thalamus, STL comprised calcification and atrophy of the bilateral thalami, and BBTL comprised cystic lesions of the bilateral putamen and thalami. The cerebral lesion in the cases of BBTL were observed in the perirolandic cortex, which is a watershed area of the main vascular territories. While the cerebral lesion in the cases of STL were found in the periventricular white matter, which is a watershed area in premature babies. The brainstem was more severely injured in the case of STL than BBTL. The distribution of the affected lesions suggested that the cases with STL had a different clinicopathological syndrome from those with BBTL. We discussed the developmental mechanism of the cases.
已有许多关于新生儿缺氧缺血性脑病（HIE）导致基底节和丘脑病变病例的报道，这些病变被视为一种临床病理综合征。但脑损伤的临床症状和范围因病例而异。我们之前报道过7例因新生儿HIE导致双侧基底节和丘脑病变（BBTL）的病例。受累病变包括壳核后部、丘脑外侧、海马和中央旁小叶皮质。现在，我们又遇到了2例因新生儿HIE出现对称性丘脑病变（STL）并累及脑干和脑室周围白质的病例。在这些基底节和丘脑病变中，STL表现为双侧丘脑钙化和萎缩，BBTL表现为双侧壳核和丘脑的囊性病变。BBTL病例的脑损伤见于中央旁小叶皮质，这是主要血管区域的分水岭区。而STL病例的脑损伤见于脑室周围白质，这是早产儿的分水岭区。STL病例的脑干损伤比BBTL更严重。受累病变的分布表明，STL病例与BBTL病例具有不同的临床病理综合征。我们讨论了这些病例的发育机制。
