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Case Study 30

The brain in this case is from a male fetus following intrauterine fetal demise at 40 weeks gestation. Pathologic examination of the placenta revealed chronic villitis of unclear etiology and acute chorioamnionitis due to Strep. B infection. Autopsy of the fetus revealed no significant pathology out

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Case Study 30

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    1. Case Study 30 Julia Kofler, M.D.

    2. The brain in this case is from a male fetus following intrauterine fetal demise at 40 weeks gestation. Pathologic examination of the placenta revealed chronic villitis of unclear etiology and acute chorioamnionitis due to Strep. B infection. Autopsy of the fetus revealed no significant pathology outside the brain, no congenital anomalies and a normal karyotype. Identify the predominant pathologic process in the following slides and high-power images.

    6. Karyorrhectic cell death of numerous neurons

    7. Question 2 Which brain regions are primarily affected?

    8. Answer Subiculum and basis pontis

    9. Question 3 What is your diagnosis?

    10. Answer Pontosubicular necrosis

    11. Question 4 What is the predominant mode of cell death in pontosubicular necrosis?

    12. Answer Apoptosis

    13. Question 5 What is the cause of pontosubicular necrosis?

    14. Answer Hypoxia/ischemia

    15. Question 6 During which time period does pontosubicular necrosis occur?

    16. Answer Pontosubicular necrosis can be seen from 28 weeks gestation to 2 postnatal months The initiating hypoxic insult may occur in utero, in the perinatal or postnatal period

    17. Question 7 Name other gray matter manifestations of perinatal hypoxic-ischemic injury?

    18. Answer Cerebral cortex Basal ganglia and thalamus (the combination of neuronal loss, gliosis and abnormal myelination in these brain regions may result in a white, firm, marbled appearing lesion and is called status marmoratus) Brainstem nuclei Cerebellum (granular layer)

    19. Question 8 Which portion of cortical gyri is typically affected?

    20. Answer The depths of sulci

    21. Question 9 Hypoxic-ischemic injury to the sulcal depth gives the damaged gyrus a characteristic mushroom appearance. What is the correct term for this condition? An example can be seen in the following slide. Click here to view slide.

    22. Answer Ulegyria

    23. Question 10 Which neuronal populations are most susceptible to global hypoxic-ischemic injury in the adult brain?

    24. Answer CA1 sector of the hippocampus Purkinje cells in the cerebellum Cortical neurons in laminae 3 and 5

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