MRI scans for predicting brain damage in babies
Most people associate stroke with the elderly, but sadly some babies suffer stroke when they are born.
Using MRI scans taken soon after birth an Action Medical Research team have been able to predict accurately the extent of movement disability in young children who have suffered a stroke when they were born. This research is published in the January edition of Pediatrics.
The researchers examined MRI scans of the babies’ heads to identify the areas where brain damage had occurred. The babies’ progress was then monitored as they got older. Using this information, the team has shown that the predictions they made soon after birth, of whether a child would go on to develop mobility problems, have proved accurate. These children developed a condition known as ‘hemiplegia’, which means they have stiffness and movement difficulties. Hemiplegia’s occur in the opposite side of the body from that of the brain damage.
Their results show that about one third of children had a hemiplegia. Some, but not all, of those children had great difficulty in using the affected hand. However all children were able to walk and run independently.
Another third of the children, who did not have sufficient damage to cause a hemiplegia, did have some movement difficulties or clumsiness at early school age. This was not major, but could certainly impact on performance in school. This occured when the part of the brain, which takes the messages to the spinal cord, was involved in the stroke. These more minor problems had been difficult to detect at a younger age probably because the children were not old enough to perform more complicated tasks needed to show them.
Simon Moore, Chief Executive of Action Medical Research said: “This work is vitally important. Having such a clear indication of the patterns of brain injury from the early MRI scans enables doctors to make a clear diagnosis, give parents definite information about the future and much needed reassurance that their child’s condition will not deteriorate.”
Leading the team, Dr Frances Cowan said: “It is always devastating for a parent to be told that their child has suffered some brain injury. In our research we have been able to show which injuries to the brain result in the most debilitating conditions. Knowing early on exactly what physical outcome is likely for the child will enable interventions to be made to maximise the potential that every child has.
“It is especially important for parents and teachers to know that a child, who for the most part appears quite normal, has a genuine reason for movement difficulties. If they are slower or not so neat and tidy this is not just carelessness, they should not be reprimanded and they may need some extra time and help. What is remarkable is how well many of the children do and part of our ongoing studies involves using tests that help us to try and understand how these children cope with their stroke with often little in the way of long term problems. We hope these studies will help us to know what interventions are most likely to help ”
The team at the Hammersmith and Queen Charlotte Hospitals and Imperial College, studied 22 children in this project. They were all born at full term mostly to first-time mothers. The babies usually appeared well at birth but started to have fits within the next 12-36 hours. MRI scans done soon after the fits showed that these children had suffered brain damage due to a stroke on one side of the brain that had occurred around the time of birth.
This condition, often called neonatal stroke or cerebral infarction, affects 1-2 per four thousand babies and occurs usually in first babies. The condition is probably due to many factors occurring together. It is thought that clots of blood or small pieces of tissue from the placenta get into the blood stream and pass through to the arteries going to the brain. Many of the children also have some milder variant of how their blood clots. It is not thought that lack of oxygen during the birth process is a major factor but often labours are long and difficult, though not giving undue cause for medical concern. Usually the children are initially well enough to go to the post-natal wards with their mothers.
Currently there is no treatment for babies or children who experience such brain damage although the group are currently analysing all the data from the mothers, the pregnancies and labours to see if future guidelines may be developed that might help to avoid this condition.
Looking at the locations of the lesions in the brain, the team were able to determine whether or not the baby would develop a serious physical disability and how severe this would be if at all. The group has already shown in previous studies that if the damage seen on the scans affected the grey and white matter in three specific sites in the brain* then the babies were highly likely to develop a movement problem or hemiplegia on the other side of the body. If the damage involved fewer sites of tissue than this, then a hemiplegia did not develop and at early follow up around age 2 year, the children usually were normal.
*hemisphere, internal capsule and basal ganglia
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