Hypoxic-ischemic encephalopathy with cystic brain stem necroses and thalamic calcifications in a preterm twin

A severe and rare ischemic brain lesion in a preterm twin boy is reported. The boy was born after two weeks of anhydramnios and amnionic infection at 24 weeks of gestation. Following a difficult Caesarian section and prolonge d umbilical cord compression he developed prenatal acidosis with an umbilic al cord pH of 6.96. At the age of 7 h, heart rate variability narrowed due to severely disturbed brain stem function and the patient developed clinica l signs of hypoxic-ischemic encephalopathy. Sonography demonstrated extensi ve symmetrical brain stem and basal ganglia lesions. After a prolonged coma tose and apneic state, death occurred at the age of 25 days. Autopsy confir med columnar bilateral cavitation of basal ganglia, diencephalon, brain ste m and spinal gray matter, as well as focal calcifications in the palladium, thalamus, and brain stem. The findings highly resemble those observed afte r experimental or clinical cardiac arrest. (C) 2000 Elsevier Science B.V. A ll rights reserved.