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Jeong SY, Choi SY, Chang YP, Lee YS. Neurodevelopmental Outcomes According to Brain Injury Patterns in Neonates with Postasphyxial Hypoxic Ischemic Encephalopathy. NEONATAL MEDICINE 2017. [DOI: 10.5385/nm.2017.24.1.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Seung Yeon Jeong
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea
| | - Seo Yeol Choi
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea
| | - Young Pyo Chang
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea
| | - Young Seok Lee
- Department of Radiology, Dankook University College of Medicine, Cheonan, Korea
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Dzieciol AM, Bachevalier J, Saleem KS, Gadian DG, Saunders R, Chong WKK, Banks T, Mishkin M, Vargha-Khadem F. Hippocampal and diencephalic pathology in developmental amnesia. Cortex 2016; 86:33-44. [PMID: 27880886 PMCID: PMC5264402 DOI: 10.1016/j.cortex.2016.09.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/10/2016] [Accepted: 09/18/2016] [Indexed: 01/01/2023]
Abstract
Developmental amnesia (DA) is a selective episodic memory disorder associated with hypoxia-induced bilateral hippocampal atrophy of early onset. Despite the systemic impact of hypoxia-ischaemia, the resulting brain damage was previously reported to be largely limited to the hippocampus. However, the thalamus and the mammillary bodies are parts of the hippocampal-diencephalic network and are therefore also at risk of injury following hypoxic-ischaemic events. Here, we report a neuroimaging investigation of diencephalic damage in a group of 18 patients with DA (age range 11-35 years), and an equal number of controls. Importantly, we uncovered a marked degree of atrophy in the mammillary bodies in two thirds of our patients. In addition, as a group, patients had mildly reduced thalamic volumes. The size of the anterior-mid thalamic (AMT) segment was correlated with patients' visual memory performance. Thus, in addition to the hippocampus, the diencephalic structures also appear to play a role in the patients' memory deficit.
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Affiliation(s)
- Anna M Dzieciol
- University College London Great Ormond Street Institute of Child Health, London, UK.
| | | | | | - David G Gadian
- University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - W K Kling Chong
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Tina Banks
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
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Ten VS, Wu EX, Tang H, Bradley-Moore M, Fedarau MV, Ratner VI, Stark RI, Gingrich JA, Pinsky DJ. Late Measures of Brain Injury After Neonatal Hypoxia–Ischemia in Mice. Stroke 2004; 35:2183-8. [PMID: 15272130 DOI: 10.1161/01.str.0000137768.25203.df] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE This work was undertaken to determine to what degree long-term neurofunctional outcome of neonatal hypoxic-ischemic (HI) brain injury in mice correlates with anatomical extent of cerebral damage assessed by magnetic resonance imaging (MRI) and histopathology. METHODS On postnatal day 7, mice were subjected to HI. At 7 to 9 weeks after HI neurofunctional outcome was assessed by water-maze, rota-rod, and open-field test performance, followed by cerebral MRI and histopathology evaluation. RESULTS At 10 weeks after HI, MRI revealed ipsilateral brain atrophy alone or with porencephalic cyst formation and contralateral ventriculomegaly. Adult HI-affected mice, especially those that developed a porencephalic cyst, demonstrated significant neurofunctional deficit compared with age-matched naïve mice. HI-affected mice with ipsilateral cerebral atrophy but without porencephaly demonstrated no or an intermediate level of neurofunctional deficit. Neurobehavioral assessment of mice subjected to HI insult revealed a strong correlation between degree of brain injury and functional neurohandicap. CONCLUSIONS This is the first study to demonstrate that long-term neurofunctional outcome in mice after a neonatal HI correlates tightly with anatomical pattern/extent of cerebral damage, defined by MRI and histopathology.
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Affiliation(s)
- Vadim S Ten
- Department of Pediatrics, Columbia University, New York, NY, USA
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Whitby EH, Paley MN, Smith MF, Sprigg A, Woodhouse N, Griffiths PD. Low field strength magnetic resonance imaging of the neonatal brain. Arch Dis Child Fetal Neonatal Ed 2003; 88:F203-8. [PMID: 12719393 PMCID: PMC1721544 DOI: 10.1136/fn.88.3.f203] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Magnetic resonance (MR) imaging of the neonate has been restricted by the need to transport the sick baby to the large magnetic resonance scanners and often the need for sedation or anaesthesia in order to obtain good quality images. Ultrasound is the reference standard for neonatal imaging. OBJECTIVE To establish a dedicated neonatal MR system and compare the clinical usefulness of MR imaging with ultrasound imaging. DESIGN Prospective double blind trial. SETTING Neonatal intensive care unit, Sheffield. MAIN OUTCOME MEASURES Imaging reports. PATIENTS 134 premature and term babies. RESULTS In 56% of infants with pathology suspected on clinical grounds, MR provided additional useful clinical information over and above that obtained with ultrasound. CONCLUSION Infants can be safely imaged by dedicated low field magnetic resonance on the neonatal intensive care unit without the need for sedation at a cost equivalent to ultrasound.
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Affiliation(s)
- E H Whitby
- Department of Academic Radiology, Floor C, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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Abstract
Asphyxia remains one of the main causes of later disability in term infants. Despite many publications identifying possible predictors of outcome in this population of interest, little is known of the long-term developmental outcome of asphyxiated term neonates. Observational studies have largely focused on short-term outcomes, with an emphasis on significant neurologic sequelae and intellectual impairments. This article reviews the literature that has described the developmental outcome of asphyxiated term newborns. As part of this review, we have also highlighted the evolution of the definition of asphyxia and delineated appropriate markers that should be used in future research on this population.
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Affiliation(s)
- M E Dilenge
- Division of Pediatric Neurology, Montreal Children's Hospital, PQ.
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Abstract
Our knowledge about the cause of cerebral palsy continues to expand and prenatal events are thought to play an important role. This article reviews laboratory tests, imaging studies and pathologic findings that have been used to identify the timing of neurological injury. Limitations exist for all modalities, however, imaging studies, electroencephalograms and pathologic examination provide the most useful information. Improvements in our ability to time neurological injury will better direct our efforts to prevent cerebral palsy.
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Affiliation(s)
- L M Hollier
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas-Houston Medical School, 77026, USA.
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Abstract
Neocortical slices from young [postnatal day (P) 5-8], juvenile (P14-18), and adult (>P28) rats were exposed to long periods of hypoxia. Field potential (FP) responses to orthodromic synaptic stimulation, the extracellular DC potential, and the extracellular Ca2+ concentration ([Ca2+]o] were measured simultaneously in layers II/III of primary somatosensory cortex. Hypoxia caused a 42 and 55% decrease in the FP response in juvenile and adult cortex, respectively. FP responses recorded in slices from young animals were significantly more resistant to oxygen deprivation as compared with the juvenile (P < 0.01) and adult age group (P < 0.001) and declined by only 3% in amplitude. In adult cortex, hypoxia elicited, after 7 +/- 4.5 min (mean +/- SD), a sudden anoxic depolarization (AD) with an amplitude of 14 +/- 6 mV and a duration of 0.89 +/- 0.28 min at half-maximal amplitude. Although the AD onset latency was significantly longer in P5-8 (12.5 +/- 4.9 min, P < 0.001) and P14-18 (8.7 +/- 3.2 min, P < 0.002) cortex, the amplitude and duration of the AD was larger in young (45.7 +/- 7.6 mV, 2.19 +/- 0.71 min, both P < 0.001) and juvenile animals (29.9 +/- 9.1 mV, P < 0.001, 0.96 +/- 0.26 min, P > 0.05) when compared with the adults. The hypoxia-induced [Ca2+]o decrease was significantly (P < 0.002) larger in young cortex (1,115 +/- 50 microM) as compared with the adult (926 +/- 107 microM). Prolongation of hypoxia after AD onset for >5 min elicited in young and juvenile cortex a long-lasting AD with an amplitude of 40.5 mV associated with a decrease in [Ca2+]o by >1 mM. On reoxygenation, only slices from these age groups showed spontaneous repetitive spreading depression in 3 out of 26 cases. In adults, the same protocol caused a significantly (P < 0.05) smaller and shorter AD and never a spreading depression. However, recovery in synaptic transmission after this long-term hypoxia was better in young and juvenile cortex, indicating a prolonged or even irreversible deficiency in synaptic function in mature animals. Application of ketamine caused a 49% reduction in the initial amplitude of the AD in juvenile cortex but did not significantly affect the AD in slices from adult animals. These data indicate that the young and juvenile cortex tolerates much longer periods of oxygen deprivation as compared with the adult, but that a sufficiently long hypoxia causes severe pathophysiological activity in the immature cortex. This enhanced sensitivity of the immature cortex is at least partially mediated by activation of N-methyl-D-aspartate receptors.
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Affiliation(s)
- H J Luhmann
- Institute of Neurophysiology, University of Düsseldorf, Germany
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Olsén P, Pääkkö E, Vainionpää L, Pyhtinen J, Järvelin MR. Magnetic resonance imaging of periventricular leukomalacia and its clinical correlation in children. Ann Neurol 1997; 41:754-61. [PMID: 9189036 DOI: 10.1002/ana.410410611] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The prevalence of periventricular leukomalacia and its association with clinical neurological signs in school-age preterm children are unknown. We matched 42 eight-year-old children who were born before term with birth weights lower than 1,750 gm (mean, 1,410 gm; gestational age, 31 weeks) with 42 children who were born at term and of normal birth weight, to compare clinical neurological status and magnetic resonance imaging findings. Of the children born prematurely, 9.5% had cerebral palsy and 31% had minor neurological dysfunction whereas 9% of the children born at term had minor neurological dysfunction and none had cerebral palsy. Deviations in tongue movements, heel walking. Fogs test results, and finger opposition, as well as behavioral disturbances, differentiated the preterm from the full-teem group. The prevalence of periventricular leukomalacia among all children born prematurely was 32%. It was observed in all children with cerebral palsy, in 25% with minor neurological dysfunction, and in 25% of the clinically healthy preterm children. None of the children born at term had evidence of periventricular leukomalacia. Children with periventricular leukomalacia especially demonstrated poor performance on heel walking and Fogs test. Though commonly found in preterm children, periventricular leukomalacia is not uniformly associated with abnormal neurological findings. A thorough neurological examination is a better predictor of later developmental problems than is magnetic resonance imaging.
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Affiliation(s)
- P Olsén
- Department of Pediatrics, University of Oulu, Finland
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Luhmann HJ, Raabe K. Characterization of neuronal migration disorders in neocortical structures: I. Expression of epileptiform activity in an animal model. Epilepsy Res 1996; 26:67-74. [PMID: 8985688 DOI: 10.1016/s0920-1211(96)00041-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hypoxia, ischemia and other forms of brain injury during the pre- and perinatal period may cause neuronal migration disorders which results in irreversible structural modifications. In human neocortex, these malformations have been associated with severe mental retardation, motor dysfunction and the manifestation of therapy-resistant epilepsy. We were interested in analyzing the expression of epileptiform activity in an animal model of neocortical migration disorders. Newborn rats received a focal freeze lesion and were investigated anatomically and in vitro electrophysiologically after survival times of up to five months. Anatomic abnormalities included loss of normal cortical lamination (focal microgyrus) and presence of ectopic cell clusters in layer I and in the white matter (heterotopia). The functional in vitro analyses with eight extracellular recording electrodes revealed a prominent hyperexcitability of the disorganized neocortical network. Electrical stimulation of the afferents elicited epileptiform responses that propagated over > 4 mm in the horizontal direction. In untreated and sham-operated animals, this spread of evoked activity was restricted to 0.5-1 mm. Epileptiform responses were not significantly affected by APV but blocked by NBQX, indicating that AMPA receptors play a prominent role in the generation and propagation of this pathophysiological activity. Our data suggest that the experimentally induced migration disturbances cause long-term structural and/or functional modifications in the neocortical network which may form the basis for the expression of epileptiform activity.
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Affiliation(s)
- H J Luhmann
- Institute of Physiology II, Department of Neurophysiology, Düsseldorf, Germany.
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