Neurology - Perinatal Brain Injury

Question 1

Pre-term brain v full-term brain

Answer 1

• Less developed cortical folding (smoother surface)
• Immature vasculature, prone to fluctuations in cerebral blood flow
• Vulnerable to white matter injury (periventricular leukomalacia PVL)
• Lower myelination and weaker synaptic connections

Question 2

List of perinatal brain injuries

Answer 2

Periventricular Leukomalacia (PVL)
Intraventricular haemorrhage (IVH)
Hypoxic-Ischaemic Encephalopathy (HIE)

Question 3

Periventricular Leukomalacia (PVL)

Answer 3

Ishcaemia injury to periventricular white matter due to hypoxia-ischaemia in pre-term infants.
- Periventricular = around the ventricles
- Leuko = white
- Malacia = softening/damage
- Leads to impaired myelination (white matter contains axons covered in myelin) → affects movement, coordination, learning
- Clinical outcome = CP - spastic diplegia, congenital defects

Question 4

Intraventricular Haemorrhage (IVH)

Answer 4

Haemorrhage from the fragile germinal matrix into the ventricles where cerebrospinal fluid (CSF) flows.
- germinal matrix = delicate, highly vascular area that disappears at term - vessels can easily rupture due to high BP, respiratory distress, hypoxia
- Severity (grades I-IV); higher grades associated with hydrocephalus and neurodevelopmental impairment
- Prevention: control BP fluctuations by optimising ventilation

Question 5

HIE v PVL v IVH

Answer 5

HIE affects full term neonates as it relates to damaged cortex and deep grey matter which is more developed.
PVL affects pre-term neonates as it relates to damaged white matter (periventricular) which is still developing and is more vulnerable.
IVH affects pre-term neonates as it relates to the delicate germinal matrix that typically disappears at term

Question 5

Hypoxic-Ischaemic Encephalopathy (HIE)

Answer 5

Neurological injury to deep grey matter due to hypoxia and/or ischaemia leading to cell death. Phases include primary energy failure (initial hypoxia/ischaemia), latency (reperfusion injury), secondary energy failure

Question 6

Outcomes of perinatal brain injury

Answer 6

• Increased risk of cerebral palsy (CP), esp. spastic diplasia
• Executive dysfunction, cognitive deficits, ADHD, ASD
• Intellectual disability and delayed speech

Question 7

Prevention of perinatal brain injury

Answer 7

• TH
• Antenatal steroids for pre-terms
• Optimised neonatal care (BP regulation, oxygenation, stable blood sugar)