Advertisement

Two patterns of perinatal brain damage and their conditions of occurrence

  • Ronald E. Myers
    Affiliations
    Laboratory of Perinatal Physiology, National Institute of Neurological Diseases and Stroke, National Institutes of Health, United States Public Health Service, Department of Health, Education, and Welfare Bethesda, Maryland, USA
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Term monkey fetuses may be subjected to episodes of total asphyxia characterized by complete stoppage of respiratory gas exchange. Such animals, after resuscitation and extended survival, exhibit damage to structures in their brainstems. This injury pattern fails to resemble that found after perinatal damage in the human being. Term monkey fetuses subjected to episodes of partial asphyxia, on the other hand, exhibit injury to structures in the hemispheres. This damage, when severe, may consist of a total bilateral hemispheral necrosis. With less severe injury, the necrosis may be restricted to the middle third of the paracentral region and/or to the basal ganglia. After prolonged survival, areas of necrosis are transformed into areas of nodular cortical atrophy, white matter sclerosis, and status marmoratus of the basal ganglia. These eventual long-term, static lesions closely compare to the lesions of human perinatal injury or cerebral palsy. Episodes of in utero fetal partial asphyxia may be brought about in a variety of ways, many of which, in one fashion or another, reduce maternal blood flow through the placenta. Retardation of placental intervillous space perfusion, in turn, diminishes the net exchange of respiratory gases between the mother and the fetus and leads to varying degrees of hypoxia, hypercarbia, and acidosis. Episodes of fetal bradycardia and hypotension following uterine contractions (Type II dips) may appear with severe asphyxia. Such hypotensive episodes may be associated with impairments of cerebral perfusion which, when repeated, may contribute to fetal brain injury. Maternal stimulation with exogenous or endogenous catecholamines leads to fetal asphyxia by producing maternal visceral vasoconstriction, thereby reducing maternal blood flow to the uterus. The tendency for perinatal asphyxia to be associated with myocardial injury and heart failure is emphasized. More babies die of cardiovascular failure secondary to myocardial injury than survive less severe disturbances in heart action to exhibit brain damage.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ranck J.B.
        • Windle W.F.
        Exp. Neurol. 1959; 1: 130
        • Windle W.F.
        Science. 1963; 140: 1186
        • Myers R.E.
        Adamsons K. Diagnosis and Treatment of Fetal Disorders. Springer-Verlag, New York1969: 226
        • Myers R.E.
        Goldsmith E.J. Moor-Jankowski J. Medical Primatology 1970. S. Karger AG, Basel1971: 394-425
        • Dawes G.S.
        Foetal and Neonatal Physiology, A Comparative Study of the Changes at Birth. Year Book Medical Publishers, Inc, Chicago1968: 141-159
        • Adamsons K.
        • Behrman R.
        • Dawes G.S.
        • Dawkins M.J.R.
        • James L.S.
        • Ross B.B.
        J. Physiol. 1963; 169: 679
        • Dawes G.S.
        • Jacobson H.N.
        • Mott J.C.
        • Shelly H.J.
        • Stafford G.
        J. Physiol. 1963; 169: 167
      1. Myers, R. E.: In preparation.

        • Mossakowski M.J.
        • Long D.M.
        • Myers R.E.
        • Rodriguez de Curet H.
        • Klatzo I.
        J. Neuropathol. Exp. Neurol. 1968; 27: 500
        • Rivera A.
        • Brann A.W.
        • Myers R.E.
        Exp. Neurol. 1970; 26: 309
        • Villee C.A.
        James L.S. Myers R.E. Gaull G.E. Brain Damage in the Fetus and Newborn from Hypoxia or Asphyxia. Report of the Fifty-seventh Ross Conference on Pediatric Research. Ross Laboratories, Columbus1967: 47
        • Kety S.
        Schade J.P. McMenemey W.H. Selective Vulnerability of the Brain in Hypoxemia. F. A. Davis Company, Philadelphia1963: 21
        • Sokoloff L.
        Pharmacol. Rev. 1959; 11: 1
        • Horstmann E.
        Tower D.B. Schadé J.P. Structure and Function of the Cerebral Cortex. Elsevier Publishing Company, Amsterdam1960: 59
        • Miller Jr., J.A.
        • Miller F.S.
        Dev. Med. Child Neurol. 1965; 7: 607
        • Cockburn F.
        • Daniel S.S.
        • Dawes G.S.
        • James L.S.
        • Myers R.E.
        • Niemann W.
        • Rodriguez de Curet H.
        • Ross B.B.
        J. Pediatr. 1969; 75: 281
        • Myers R.E.
        James L.S. Myers R.E. Gaull G.E. Brain Damage in the Fetus or Newborn from Hypoxia or Asphyxia. Report of the Fifty-seventh Ross Conference on Pediatric Research. Ross Laboratories, Columbus1967: 108
        • Brierley J.B.
        Proceedings of Fifth International Congress of Neuropathology, AmsterdamExcerpta Medica International Congress Series No. 100. 1966: 21
        • Brierley J.B.
        James L.S. Myers R.E. Gaull G.E. Brain Damage in the Fetus or Newborn from Hypoxia or Asphyxia. report of the Fifty-seventh Ross Conference on Pediatric Research. Ross Laboratories, Columbus1967: 26
        • Miller J.R.
        • Myers R.E.
        Neurology. 1970; 20: 715
        • Miller J.R.
        • Myers R.E.
        Neurology. 1971; 21 (In press)
        • Myers R.E.
        Perinatal Factors Affecting Human Development, Washington. Pan American Health Organization Scientific Publication No. 185. 1969: 205
        • Balentine J.D.
        Am. J. Pathol. 1968; 53: 1097
        • Miller Jr., J.A.
        • Gribbe P.
        • von Hedenberg C.
        • Wegelius C.
        Anat. Rec. 1960; 136: 244
        • Miller Jr., J.A.
        • Miller F.S.
        Am. J. Obstet. Gynecol. 1962; 48: 44
        • Adamsons K.
        • Behrman R.
        • Dawes G.S.
        • Koford C.
        J. Pediatr. 1964; 65: 807
        • Miller Jr., J.A.
        • Miller F.S.
        Musacchia X.J. Saunders J.F. Depressed Metabolism. Elsevier Publishing Company, Amsterdam1969: 427
        • Myers R.E.
        Crosignani P.G. Pardi G. Fetal Evaluation During Pregnancy and Labor: Experimental and Clinical Aspects. Academic Press, Inc, New York1971: 175-199 (1971)
        • Myers R.E.
        • Beard R.
        • Adamsons K.
        Neurology. 1969; 19: 1012
        • Brann A.W.
        • Myers R.E.
        Goldsmith E.I. Moor-Jankowski J. Medical Primatology 1970. S. Karger AG, Basel1971: 637-643
        • Adamsons K.
        • Mueller-Heubach E.
        • Myers R.E.
        Am. J. Obstet. Gynecol. 1971; 109: 248
        • Perloff J.K.
        • Talano J.V.
        • Ranon J.A.
        Progr. Cardiovasc. Dis. 1971; 13: 437
        • Myers R.E.
        Crosignani P.G. Pardi G. Fetal Evaluation During Pregnancy and Labor: Experimental and Clinical Aspects. Academic Press, Inc, New York1971: 288-293 (1971)
      2. Selzer, M. E., Myers, R. E., and Holstein, S. B.: In preparation.

        • Lindenberg R.
        J. Neuropathol. Exp. Neurol. 1955; 14: 223
        • Reivich M.
        • Brann A.W.
        • Shapiro H.
        • Myers R.E.
        Fourth Salzburg Conference on Cerebral Flow. 1970
        • Brierley J.B.
        Brierley J.B. Meldrum B.S. Brain Hypoxia. Spastics International Medical Publications, London1971: 20-23
        • Selzer M.E.
        • Myers R.E.
        • Holstein S.B.
        Neurology. 1971; 21 (In press)
        • Bondareff W.
        • Myers R.E.
        • Brann A.W.
        Exp. Neurol. 1970; 28: 167
        • Malamud N.
        J. Neuropathol. Exp. Neurol. 1959; 18: 141
        • Malamud N.
        Schadé J.P. McMenemey W.H. Selective Vulnerability of the Brain in Hypoxaemia. F. A. Davis Company, Philadelphia1963: 211
        • Towbin A.
        The Pathology of Cerebral Palsy. Charles C Thomas, Publisher, Springfield1960: 23
        • Courville C.B.
        Birth and Brain Damage, An Investigation into the Problems of Antenatal and Paranatal Anoxia and Allied Disorders and Their Relation to the Many Lesion-Complexes Residual Thereto. Margaret Farnsworth Courville, Pasadena1971: 1
        • Myers R.E.
        Neurology. 1969; 19: 1177
        • Myers R.E.
        Arch. Neurol. 1969; 21: 133