Maller A I, Hankins L L, Yeakley J W, Butler I J
Department of Neurology, University of Texas-Houston, Medical School, 77030, USA.
J Child Neurol. 1998 Jul;13(7):313-21. doi: 10.1177/088307389801300702.
Magnetic resonance images (MRIs) of the brains of 11 patients aged from 1 week to 12 years with a distinctive type of cerebral palsy were selected based on distribution of cerebral lesions, which were restricted to bilateral perirolandic cortical and subcortical regions, including frequent symmetric involvement of basal ganglia and ventrolateral nucleus of thalami. Retrospectively, the perinatal history and clinical features were reviewed to correlate clinical data with this distinctive pattern of brain injury. Clinically affected neonates had an encephalopathy associated with a severe perinatal asphyxial event. Older children with cerebral palsy survived a similar perinatal course and demonstrated spastic quadriparesis with bulbar or pseudobulbar involvement, lack of verbal speech and variable delays in cognitive development. The distribution of hypoxic-ischemic lesions involving bilateral perirolandic regions, basal ganglia, and thalami, appears to correlate with increased metabolic areas of primary myelination in full-term neonates, but not with arterial border zones nor a single cerebral artery distribution. Myelination is a critical process in maturing brain associated with marked increase in tissue respiration and thus greater susceptibility to oxygen deprivation. It is believed that the extent of hypoxic-ischemic brain injury is determined principally by brain maturity and regional metabolic rates at time of insult and this correlates with active myelination in full-term neonates. This study confirms previous data from neuropathologic literature and recent reports of neuroimaging studies of asphyxiated neonates. In addition, retrospective analysis of the clinical data enables recognition of a type of cerebral palsy that might be the hallmark of hypoxic-ischemic injury in term neonates.
根据脑损伤的分布情况，从11例年龄在1周至12岁之间、患有一种特殊类型脑瘫的患者中选取了脑部的磁共振成像（MRI）。这些脑损伤局限于双侧中央前回皮质及皮质下区域，包括基底神经节和丘脑腹外侧核频繁的对称性受累。回顾性地分析围产期病史和临床特征，以将临床数据与这种独特的脑损伤模式相关联。临床上受影响的新生儿患有与严重围产期窒息事件相关的脑病。患有脑瘫的大龄儿童经历了类似的围产期过程，表现为痉挛性四肢瘫，伴有延髓或假性延髓受累、言语缺失以及认知发育的不同程度延迟。缺氧缺血性损伤累及双侧中央前回区域、基底神经节和丘脑的分布，似乎与足月儿原发性髓鞘形成增加的代谢区域相关，但与动脉边缘带或单一脑动脉分布无关。髓鞘形成是成熟大脑中的一个关键过程，与组织呼吸的显著增加相关，因此对缺氧更敏感。据信，缺氧缺血性脑损伤的程度主要由损伤时的脑成熟度和区域代谢率决定，这与足月儿的活跃髓鞘形成相关。本研究证实了神经病理学文献中的先前数据以及窒息新生儿神经影像学研究的近期报告。此外，对临床数据的回顾性分析能够识别一种可能是足月儿缺氧缺血性损伤标志的脑瘫类型。
