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POSTASPHYXIAL
HYPOXIC-ISCHEMIC
ENCEPHALOPATHY
Models
of
association
between
risk
factors
and
severe
adverse
outcome
within
4
hours
of
birth
were
determined
in
178
infants
with
postasphyxial
hypoxic-ischemic
encephalopathy
(PA-HIE)
admitted
consecutively
between
1985
and
1992
to
the
regional
referral
neonatal
ICU
at
the
Hospital
for
Sick
Children,
Toronto,
Canada.
Of
165
infants
with
known
outcomes,
88
(53%)
had
severe
adverse
outcome,
48
died
(42
in
the
first
month),
and
40
had
severe
impairment
and
microcephaly
at
1
year.
Rates
of
PA-HIE
and
severe
adverse
outcome
were
0.4
and
0.2/1000
births;
the
rate
of
PA-cerebral
palsy
was
0.1/1000
births.
Delayed
onset
of
breathing,
administration
of
chest
compressions,
and seizures
at
less
than
4
hours
of
age
were
most
predictive
of
adverse
outcome.
(Ekert
P,
Perlman
M,
Steinlin
M,
Hao
Y.
Predicting
the
outcome
of
postasphyxial
hypoxic-ischemic
encephalopathy
within
4
hours
of
birth.
I
Pediatr
Oct
1997;131:613-617).
(Reprints:
Max
Perlman
MB,
FRCP,
Division
of
Neonatology, Department
of
Pediatrics,
Hospital
for
Sick
Children,
555
University
Aver,
Toronto,
Ontario,
M5G
1X8,
Canada).
COMMENT.
Three
independent predictors
in
the
first
4
hours
after
birth
may
be
used
as
clinical
markers
of
severe
adverse
outcome
of
asphyxia
and
HIE:
apnea
duration,
chest compressions,
age
at
onset
of
seizures.
Measurements
of
CBF
with
PET
during
the
neonatal
period
may
also
be
predictive
of
childhood
neurologic
outcome.
Neonatal
cerebral
blood
flow
(CBF)
and
childhood
IQ.
and
neurologic
outcome.
A
significant negative
correlation
between
neonatal
CBF
and
childhood
IQ.
measured
at
ages
4
to
12
years
was
found
in
a
study
at
Washington
University
School
of
Medicine,
St
Louis,
MO.
The
mean
neonatal
CBF
in
8
with
abnormal
childhood
neurologic
outcome
was
higher
than
in
8
with
normal
neurologic
evaluations.
Higher
CBF
correlated
with
lower
IQ,
(Rosenbaum
JL,
Almli
CR,
Yundt
KD,
Altman
DI,
Powers
WJ.
Higher
neonatal
cerebral
blood flow
correlates
with
worse
childhood
neurologic
outcome.
Neurology
Oct
1997;49:1035-1041).
CONGENITAL
PORENCEPHALY
AND
HIPPOCAMPAL
SCLEROSIS
MRI
volumetric
findings
were
correlated
with
seizure
patterns
and
EEGs
in
14
patients
with
intractable
seizures,
porencephaly
and
hippocampal
sclerosis
(HS)
in
a
study
at
the
University
of
Alabama,
Birmingham,
AL.
Psychoparetic complex
partial
seizures
(CPS)
occurred
in
10,
simple
partial
seizures
in
3,
and
generalized
TC
seizures
in
1.
EEGs
showed
ictal
or
interictal
temporal localization
in
9
(64%)
patients
with
CPS.
Porencephaly
was
distant
from
the
temporal
area
and
in
the
middle
cerebral
artery
distribution
in
8;
it
was
related
to
the
posterior
cerebral
in
only
3.
Hippocampal
formation
atrophy
in
13
(93%)
patients
was
concordant
with
CPS
and
EEG
temporal
localization
in
70%
cases.
Ten
had
amygdala atrophy,
concurrent
with
HS
in
57%.
Two
with
HS
were
seizure
free
after
temporal
lobectomy.
A
common
ischemic
pathogenesis
is
proposed
for
the
dual
pathology
involving
both
porencephaly
and
mesial
temporal
sclerosis.
HS
is
the
most
likely
origin
for
CPS
in
patients
with
EEG
temporal
localization.
(Ho
SS,
Kuzniecky
RI,
Gilliam
F,
Faught
E,
Bebin
M,
Morawetz
R.
Congenital
porencephaly
and
hippocampal
sclerosis.
Clinical
features
and
epileptic
spectrum.
Neurology
Nov
1997;49:1382-1388). (Reprints: Dr
Ruben
I
Kuzniecky,
Department
of
Neurology,
UAB
Station,
Birmingham,
AL
35294).
COMMENT.
Patients
presenting
with
intractable
complex
partial
seizures
90