CENTRAL CORTICO-SUBCORTICAL INVOLVEMENT - A DISTINCT PATTERN OF BRAIN-DAMAGE CAUSED BY PERINATAL AND POSTNATAL ASPHYXIA IN TERM INFANTS

Objective: The MR findings in a characteristic pattern of hypoxic-isch emic brain damage in term infants are described. Materials and Methods : The MR images of seven patients with cerebral palsy and a specific p attern of central cortico-subcortical cerebral damage were studied ret rospectively and correlated with clinical findings. Results: All seven patients were born at term. Five of the seven patients had a clear hi story of severe perinatal asphyxia. All children had severe encephalop athic symptomatology, including spastic tetraplegia, extrapyramidal sy mptoms, and a mental deficit. The MR showed localized atrophy of the c ortex and in addition cystic changes, gliosis, and tissue loss of the adjacent white matter. In all patients, the lesions were band shaped i n the left-right direction and characteristically located in areas bor dering the central sulcus. The segment of the corpus callosum underlyi ng the affected area was always thin. In some patients, lesions were a lso found bilaterally in the occipital regions, hippocampus, and basal ganglia. The areas involved match the regions that are known to show active myelination on MR in the term neonate. Conclusion: Recognition of this specific pattern on MR in children with cerebral palsy enables the classification of such lesions as resulting from peri- or postnat al asphyxia, even if the perinatal history is unknown or equivocal, an d makes other etiologies less likely.