Delayed neurological signs following isolated parasagittal injury in asphyxia at term.
BACKGROUND
Parasagittal cerebral injury is a type of cerebral injury in term infants, which is characterized by the predominant injury of the arterial border zones of the anterior, middle and posterior cerebral arteries, however its early clinical manifestation is mostly unclear.


OBJECTIVE
To understand early clinical features of parasagittal cerebral injury.


METHODS
The clinical details of 18 newborn infants who were diagnosed as having parasagittal cerebral injury on magnetic resonance imaging (MRI). Eleven infants had localized injury within parasagittal regions ("Limited" group), 7 infants had diffuse extensive injury involving the deep gray matter and/or periventricular white matter ("Extensive" group). These infants were compared with 9 infants with perinatal asphyxia without MRI abnormalities ("Normal" group).


RESULTS
There was no significant difference in the rate of cardiotocographic abnormalities, low Apgar scores, low blood pH and base excess, and the requirement for mechanical ventilation among three groups. Compared with the Normal group, fewer infants in the Limited group developed neonatal encephalopathy within an hour after birth. Neonatal seizures were more frequent in the Limited and the Extensive groups. Hepatic and/or renal dysfunction was more often observed in the Limited group. Cerebral palsy and/or mental retardation were common in the Extensive group. Electro-cortical depression was more in the Extensive group. Progressive suppression of electro-cortical activity was common within infants in the Limited group (33%) and the Extensive group (60%).


CONCLUSIONS
Infants with parasagittal cerebral injury developed serious neurological abnormalities despite less serious physiological and neurological manifestation shortly after birth, suggesting the importance of careful longitudinal observation of asphyxiated infants.
Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan. yoshiakisato@nifty.com
Yoshiaki
Y
Sato
Masahiro
M
Hayakawa
Osuke
O
Iwata
Akihisa
A
Okumura
Toru
T
Kato
Fumio
F
Hayakawa
Tetsuo
T
Kubota
Koichi
K
Maruyama
Masayuki
M
Hasegawa
Machiko
M
Sato
Makoto
M
Oshiro
Osamu
O
Kito
Seiji
S
Kojima
D001238:Asphyxia Neonatorum / Q000150:complications* / Q000473:pathology / Q000503:physiopathology*; D002536:Cerebral Arteries / Q000033:anatomy & histology / Q000503:physiopathology*; D002540:Cerebral Cortex / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology*; D002547:Cerebral Palsy / Q000209:etiology; D002560:Cerebrovascular Circulation / Q000502:physiology; D013181:Cortical Spreading Depression; D003937:Diagnosis, Differential; D004569:Electroencephalography; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000150:complications* / Q000473:pathology / Q000503:physiopathology*; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000209:etiology; D007674:Kidney Diseases / Q000209:etiology; D007969:Leukomalacia, Periventricular / Q000209:etiology; D008107:Liver Diseases / Q000209:etiology; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D013997:Time Factors