Case Study 30
Transcript Case Study 30
Case Study 30
Julia Kofler, M.D.
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.
Karyorrhectic cell death of numerous neurons
Which brain regions are primarily affected?
Subiculum and basis pontis
What is your diagnosis?
What is the predominant mode of cell death in
What is the cause of pontosubicular necrosis?
During which time period does pontosubicular necrosis
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
Name other gray matter manifestations of perinatal
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
Cerebellum (granular layer)
Which portion of cortical gyri is typically affected?
The depths of sulci
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.
Which neuronal populations are most susceptible to
global hypoxic-ischemic injury in the adult brain?
CA1 sector of the hippocampus
Purkinje cells in the cerebellum
Cortical neurons in laminae 3 and 5