新生儿缺氧缺血脑病(HIE) 七年制2010精品.pptVIP

This periventricular primitive zone is called the germinal matrix. During 24-32 gestation much of the germinal matrix is localized bilaterally over the caudate nucleus where it lies just beneath the ependymal lining of the lateral ventricles. The vast majority of neonatal intracerebral hemorrhage begins in the germinal matrix. It may remain localized or may rupture through the overlying ependymal cell layer into the lateral ventricles (the red arrow points to the germinal matrix). Depending on the extent of the bleeding, the hemorrhage may fill up and expand the ventricular system, follow the course of the CSF to emerge in the subarachnoid space overlying the brainstem and cerebellum, or may occasionally show expansion into the parenchyma. A major complication in survivors is post hemorrhagic hydrocephalus or dilatation of the ventricles. This is due to fibrotic organization of the arachnoid space or plugging of the channels between the fourth ventricle and the subarachnoid space. Acute eosinophilic necrosis of neurons with shrinkage of the cytoplasm, karyorrhexis and pyknosis of the nucleus This image shows the brain some time after a severe case of perinatal asphyxia. The gyri have become thinned, white and firm with loss of the demarcation between the gray and white matter (ulegyria). If necrosis has been extensive, cystic lesions may develop. Fairly well demarcated yellow-white chalky lesions which are typically located bilaterally in the white matter, typically at the corners of the lateral ventricles. Clinical: Because of their location in the region of the corticospinal tracts, the neurological sequelae of severe WMD may be spastic diplegia or quadriplegia (which is often given the label of cerebral palsy). 1周龄早产儿PVL(left) Picture 1. Cranial ultrasound, coronal view, in 1-week-old premature infant. The periventricular echotexture is abnormally increased (greater than or equal to that of the choroid plexus), which is consistent with the early changes of