Anatomy of a Birth Brain Injury
The brain consists of three major sections. The most prominent of these is the cerebrum, which has the classic folded pattern associated with the organ and has right and left hemispheres. Vision, hearing, touch, coordination of movement, speech, problem solving, judgement, learning, and reasoning or controlled here.Get A 100% Free CASE Evaluation
Anatomical Evidence of Brain Injuries
Through various methods of scanning, traumatic brain injuries take many forms and are identified by their nature and location. The types of encephalopathy, a general term for brain trauma, is typically named and diagnosed by the anatomical area affected. The basic types of injuries, from an anatomical perspective, include:
Blood can collect in or outside the brain, forming a hematoma. A subarachnoid hemorrhage is blood that pools up between the brain itself and the meninges, or layers of tissue that surround it. There are three basic types of hematomas. The subdural type involves blood that build up between the dura mater (outermost layer of protective tissue) and pia-arachnoid mater (innermost layer surrounding the brain/spinal cord). It is caused by blunt head trauma and often occurs due to cortical vein lacerations or damage to veins that pass between the cortex and dural sinuses.
An epidural hematoma is when blood is found between the dura matter and skull bone. It tends to be large and expand rapidly, as severe arterial bleeding is often the cause. Often cause by a temporal bone fracture, this injury typically involves the middle meningeal artery. A scan may also find blood collecting inside the brain, called an intracerebral hematoma. This pathology can increase intracranial pressure and cause herniation and brain stem failure.
Selective Neuronal Necrosis
A diffuse neuronal injury resulting from a vascular interruption can affect the cerebral cortex, hippocampus, cerebellum, or brainstem. The first type of selective neuronal necrosis in term infants involve these areas and possibly the thalamus, deep nuclear gray matter, and other deep brain regions. Brain stem, cerebellum, and spinal cord lesions often come with poor prognoses.
A cerebral-deep nuclear neuronal injury is a risk in hypoxic-ischemic term infants. Vascular damage is moderate to severe, so the long-term outcome is often poor. A deep nuclear gray matter-brain stem form of necrosis comes from an abrupt injury and usually affects just the deep gray matter. Cerebral involvement isn’t typical, but the thalamus, basal ganglia, and parts of the brainstem may be affected. Infants are more likely to survive if the brainstem lesion is less severe. More common in premature infants, pontosubicular necrosis involves injury to ventral pons and a part of the hippocampus called the subiculum. Like other forms of cell death, this injury can be potentially fatal or disabling.
Diffuse Brain Swelling
Swelling may not be in one specific area. This is more common in cases of birth asphyxia. Infants that undergo secondary reperfusion may present with diffuse brain swelling as well. It can be damaging on a cellular and vascular level. Intracranial pressure monitoring is often required and procedures to decompress the brain are often needed, possibly on both sides, or bilaterally.
Skull fractures don’t always affect the brain. However, depressed fractures are more likely to tear the dura tissues and damage the underlying brain tissue. Linear skull fractures in infants can cause the meninges to be entrapped between the bone fragments; a cyst can form and the original fracture can expand. A temporal bone fracture near the middle meningeal artery can trigger an epidural hematoma. Other fractures that carry a risk of brain injury include those that cross a major dural sinus, involve the carotid canal (causing carotid artery dissection), or involve the occipital bone and base of the skull.
Parasagittal Cerebral Injury
This type of injury occurs over the cerebral cortex and associated parasagittal white matter in term infants. Usually bilateral, the injury often results from low blood pressure between the front, middle, and rear cerebral circulation. An isolated lesion can affect neurodevelopment, but the prognosis is often better than for infants with deep tissue injuries.
Other Anatomical Birth Brain Injuries
Periventricular leukomalacia describes necrotic cell damage to the brain’s white matter near the lateral ventricle. It can occur in premature and term infants. In premature babies, diffuse and cystic types of the condition increase the risk of issues with neurological development. Other anatomical defects associated with encephalopathy, a general term for brain trauma, include arterial lesions that lead to ischemic perinatal stroke, and crushes and lacerations that indicate direct damage to a region of the brain.