Chapter 4 - Neuropathology of pregnancy and delivery: Mother and child

Abstract

Cerebral palsy can be used to illustrate a general approach to cases submitted for neuropathologic consultation that involve the pregnant woman, fetus, or young child. Cerebral palsy, a clinical term, has been defined as “a group of conditions that are characterized by chronic disorders of movement or posture; it is cerebral in origin, arises early in life, and is not the result of progressive disease.” The neuropathologic substrate of cerebral palsy is quite variable from case to case, because a number of lesions may result in this spectrum of clinical features. It follows that, from a neuropathologic standpoint, cerebral palsy is a syndrome rather than a disease entity and may well have a progressive underlying structural component when the brain is studied by special techniques, albeit not necessarily obvious clinically. A reasonable approach under such circumstances is to evaluate each case with the aid of guidelines such as those recommended in the consensus statement of the International Cerebral Palsy Task Force, keeping in mind that the legal profession's approach to such issues may not be identical. In this chapter, conditions in mother and child, which are more likely to be encountered by the forensic neuropathologist, are emphasized. Thus, fatal conditions such as cerebrovascular catastrophes are considered, but other neurologic conditions simply potentially aggravated by pregnancy, which are less likely to present to a medical examiner than to a clinician (for example, multiple sclerosis), are generally omitted. Reviews of pregnancy-related deaths that include non-CNS causes have recently appeared in the forensic literature, and provided a useful perspective for the medical examiner.