Pre-wallerian degeneration in the neonatal brain following perinatal cerebral hypoxia-ischemia demonstrated with MRI.
OBJECTIVE
Pre-Wallerian degeneration was studied in term and near-term neonates with hypoxic-ischemic brain injury, and related to neurodevelopmental outcome.


METHODS
Thirty-nine surviving patients with hypoxic-ischemic encephalopathy or seizures and MRI-documented brain abnormalities were included. Patients were grouped according to the MRI findings: group 1 (n = 23), ischemic stroke or watershed infarcts; group 2 (n = 8), lesions of the basal ganglia; group 3 (n = 8), predominantly white matter lesions.


METHODS
Cranial MRI, including diffusion-weighted MRI, was performed between 1 and 10 days after birth. ADC maps were created, and presence or absence of pre-Wallerian degeneration in the cerebral peduncles was assessed.


RESULTS
Of the 15 neonates with pre-Wallerian degeneration, 14 had permanent abnormalities of motor development, whereas 1 had a transient asymmetry. Six neonates with a poor outcome had no pre-Wallerian degeneration, which may be contributed to the timing of the MRI in 2. Eighteen neonates had no pre-Wallerian degeneration and a normal motor development.


CONCLUSIONS
Pre-Wallerian degeneration of the cerebral peduncles in neonates with hypoxia-ischemia is almost invariably associated with a poor motor development. In neonates with abnormalities of the basal ganglia or white matter and a poor outcome, pre-Wallerian degeneration is less common than in neonates with stroke or watershed infarcts and a poor motor outcome.
Groenendaal
Floris
F
Department of Neonatology, Division of Perinatology and Gynecology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands.
Benders
Manon J
MJ
de Vries
Linda S
LS
D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000000981:diagnostic imaging*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging*; D011859:Radiography; D014855:Wallerian Degeneration / Q000000981:diagnostic imaging* / Q000209:etiology