Transcript Case Study 30

Case Study 30
Julia Kofler, M.D.
Question 1
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.
The following powerpoint slides show high-power images of
the abnormal brain regions.
Each slide also shows gross images from a normal adult
brain to help in the identification of the abnormal brain
region. The white square indicates the brain region that
corresponds to the section in the photomicrographs.
Hint: Correct identification of the abnormal brain region
may provide a clue for the diagnosis.
Click here to view virtual slide.
http://library.med.utah.edu
http://library.med.utah.edu
Answer
Karyorrhectic cell death of numerous neurons
Question 2
Which brain regions are primarily affected?
Answer
Subiculum and basis pontis
Question 3
What is your diagnosis?
Answer
Pontosubicular necrosis
Question 4
What is the predominant mode of cell death in
pontosubicular necrosis?
Answer
Apoptosis
Question 5
What is the cause of pontosubicular necrosis?
Answer
Hypoxia/ischemia
Question 6
During which time period does pontosubicular necrosis
occur?
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
Question 7
Name other gray matter manifestations of perinatal
hypoxic-ischemic injury?
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)
Question 8
Which portion of cortical gyri is typically affected?
Answer
The depths of sulci
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.
Answer
Ulegyria
Question 10
Which neuronal populations are most susceptible to
global hypoxic-ischemic injury in the adult brain?
Answer
 CA1 sector of the hippocampus
 Purkinje cells in the cerebellum
 Cortical neurons in laminae 3 and 5