Neonatal brain MRI and motor outcome at school age in children with neonatal encephalopathy: a review of personal experience.

Eugenio Mercuri,Anna L Barnett

doi:10.1155/np.2003.51

Abstract

The aim of this paper is to review (i) the spectrum of neuromotor function at school age in children who had been born full-term and presented with neonatal encephalopathy (NE) and low Apgar scores and (ii) the relation between the presence/absence of such difficulties and neonatal brain MRI. Motor outcome appears to be mainly related to the severity of basal ganglia and internal capsule involvement. Severe basal ganglia lesions were always associated with the most severe outcome, microcephaly, tetraplegia, and severe global delay, whereas more discrete basal ganglia lesions were associated with athetoid cerebral palsy, with normal cognitive development or minor neuro-motor abnormalities. White matter lesions were associated with abnormal motor outcome only if the internal capsule was involved. Children with moderate white matter changes but normal internal capsule, had normal motor outcome at school age.

Highlights

Neonatal encephalopathy is characterized by an abnormal neurological state, with or without seizures, and affects from 2 to 8 per 1000 term infants (Nelson & Leviton, 1991; Badawi et al, 1998)
Several studies have reported that motor outcome in children with neonatal encephalopathy can be variable, ranging from normal to severe cerebral palsy, and that the severity of outcome mainly reflects the involvement of the basal ganglia on neonatal magnetic resonance imaging (MRI) (Sarnat & Sarnat, 1976; Levene et al, 1985; Viot & Lemberg, 1987; Robertson et al, 1989; Gaffney et al, 1994; Kuenzle et al, 1994; Rosenbloom, 1994; Rutherford et al, 1994; 1996; Eken et al, 1995; Mercuri et al, 1999; 2000; 2002; Barkovich et al, 1998)
We recently reported that a proportion of infants who were regarded as normal on short term follow up have minor motor abnormalities when examined at school age (Barnett et al, 2002)

Summary

Introduction

Neonatal encephalopathy is characterized by an abnormal neurological state, with or without seizures, and affects from 2 to 8 per 1000 term infants (Nelson & Leviton, 1991; Badawi et al, 1998). Several studies have reported that motor outcome in children with neonatal encephalopathy can be variable, ranging from normal to severe cerebral palsy, and that the severity of outcome mainly reflects the involvement of the basal ganglia on neonatal MRI (Sarnat & Sarnat, 1976; Levene et al, 1985; Viot & Lemberg, 1987; Robertson et al, 1989; Gaffney et al, 1994; Kuenzle et al, 1994; Rosenbloom, 1994; Rutherford et al, 1994; 1996; Eken et al, 1995; Mercuri et al, 1999; 2000; 2002; Barkovich et al, 1998). We recently reported that a proportion of infants who were regarded as normal on short term follow up have minor motor abnormalities when examined at school age (Barnett et al, 2002).

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Conclusion