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Children's Health

White Matter in Left High Frontal Lobes

11/14/2011

Question:

We have baby (5 months). at the time of birth due to lack of Oxygen supply to brain, he was on ventilator for 3-4 days. he was full term baby (9 months). Recently i have done MRI and shows following findings.

-Paucity of white matter in bilateral occipital & Left high Frontal lobe. - Thining of Corpus Callosum.

Please advise.

Answer:

Hello! You certainly had a stressful introduction to parenthood and your son to being a newborn!

The official word for not enough oxygen to the brain is Hypoxia. Needing a ventilator for 3-4 days sounds as though he had a significant period of hypoxia that made it difficult for his brain to control his breathing.

The brain uses a large amount of oxygen to supply all of its cells with what they need to work well. A period of not enough oxygen actually injures the brain cells, especially those not essential to survival because the brain redirects whatever oxygen it is getting to support the heart beating and the lungs breathing. Cells such as those in the white matter are not deemed essential, so they are injured more than other cells.

The injury is seen as "thinning of the white matter and the corpus callosum." The corpus callosum connects the two halves of the brain. Thinning means that the connection is not as strong as it needs to be for entirely normal function. The thinning of the white matter over the occipital areas means that visual information will not be processed as well by the brain as it would if there was no injury at all. Instead of thick white matter that helps preserve strong nerve signals about what the eyes are seeing, there is more water in the white matter that slows the visual messages to the brain.

Problems that some children have with this type of MRI finding include some degree of learning disability, possibly seizures, and possibly cerebral palsy. At 9 months of age, your son is in the period of time when physical therapy and other types of early learning and therapy will make a big difference in helping him to overcome the injury to his brain. It is critical that he and your family be connected to early intervention services as soon as possible. If you are in Ohio, the number to get help is 1-800-755-4769. Your son's pediatrician should also know how to help you link to services that will help him be as healthy and smart as he can be. 

Benjamin Y. Huang, MD, MPH and Mauricio Castillo, MD(2008). Hypoxic-ischemic brain injury: Imaging Ffrindings from birth to adulthood. RadioGraphics, 28, 417-439.

John H. Menkes, Harvey B. Sarnat, and Bernard L. Maria. (2006).Child neurology (7th ed.).Philadelphia, PA: Lippincott, Williams, and Wilkins: .

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University