Perinatal Period

Pathologic conditions of this period, which roughly encompasses the time from 6 to 8 weeks before birth to 4 weeks after, are (a) intracranial hemorrhages and (b) hypoxic-ischemic parenchymal necrosis. A variety of factors can cause a hemorrhage or induce a hypoxic-ischemic insult and subsequent cerebral perfusion failure (Table 14.1). Prematurity and infection of the mother and/or fetus are major risks for both hemorrhagic and

figure 14.1

Malformations of the fetal period. A. Schizencephaly or porencephaly in the brain of a 20-year old man with left hemiplegia and hypoplasia of the extremities. A large defect occcupies the lateral wall of the right hemispehere. B. Hydranencephaly in a 3-year-old boy. His delivery had been induced because of fetal distress, and the cyanotic newborn needed resuscitation. He showed no awareness of his surroundings during his entire life: he was paralyzed, had cyanotic spells, seizures, and a low temperature. The cerebral surface is smooth; in places, irregular folds represent convolutional remnants.

figure 14.1

Malformations of the fetal period. A. Schizencephaly or porencephaly in the brain of a 20-year old man with left hemiplegia and hypoplasia of the extremities. A large defect occcupies the lateral wall of the right hemispehere. B. Hydranencephaly in a 3-year-old boy. His delivery had been induced because of fetal distress, and the cyanotic newborn needed resuscitation. He showed no awareness of his surroundings during his entire life: he was paralyzed, had cyanotic spells, seizures, and a low temperature. The cerebral surface is smooth; in places, irregular folds represent convolutional remnants.

table 14.1.

Etiologies of Perinatal Vascular Pathology

Hypoxic-Ischemic

Intracranial Hemorrhages

Parenchymal Necrosis

Prematurity

Hyaline membrane disease:

Low birth weight

(Acute respiratory

Mechanical injury

distress syndrome)

Neonatal sepsis

Anomalous placenta and

Cerebral venous/sinus

umbilical cord

thrombosis

Maternal hypertension/

Vascular malformation

toxemia/anemia

Maternal hematologic diseases

Aspiration of amniotic

Maternal cocaine use

fluid

Congenital heart disease

Neonatal sepsis

Twinning: (feto-fetal

transfusion syndrome)

ischemic necroses. About 90% of preterm newborns survive; about 10% to 50% of the survivors will have some motor, cognitive, or behavioral deficits.

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