Determining the Cause of Brain Injury in the Newborn: What We Can Learn from Brain Imaging – Part One

by William Jacobson | March 11th, 2015

birth injury brain

Magnetic Resonance Imaging (MRI) may help us find the answer to the cause of a baby’s brain injury.

Physicians can be vague when asked, “What is the cause of my baby’s brain injury?” A common response is, “We will never really know.” But with magnetic resonance imaging (MRI) of the brain, there may be an answer.

The pattern of brain imaging on an MRI can often be helpful in determining when a brain injury occurred and if it was caused by asphyxiation (also known as oxygen deprivation). MRI results can also help rule out congenital, developmental, metabolic, or infectious causes of impaired brain function. The following are examples of significant brain injuries that can be detected with an MRI.

Periventricular Leukomalacia: Periventricular leukomalacia (PVL) is commonly seen on an MRI as a pattern of brain injury. In PVL, there is damage to the white matter of the brain, an area responsible for sending fast nerve impulses. If damage occurs, intelligence and motor function can be affected. It was once thought that PVL was a disease of prematurity and occurred in the developing brain during gestation. It is now known that PVL can be caused by severe lack of oxygen in a term infant. While developmental complications or congenital issues may be the cause of white matter diseases such as PVL, suffocation at birth should not automatically be ruled out.

Hypoxic-Ischemic Event: Deep gray structures of the brain control sensory, motor, and memory function.  Damage to deep grey structures can be caused by a short hypoxic-ischemic event in the term infant. This means the brain has been severely deprived of blood and oxygen for a short amount of time. For example, if the placenta tears away from the uterus, or if the uterus itself should tear, the fetus can suffer from total, or near total, suffocation for a short time until delivery and resuscitation.

If nearly all oxygen delivery to the brain is cut off for longer than ten or twenty minutes around the time of delivery, an MRI can reveal a mixed pattern of brain injury. This means white matter, gray matter, and deep grey matter of the brain are damaged.

Infant Stroke: A stroke, or bleeding in the brain, is typically depicted on an MRI as a focused area of injury. This is different from the widespread and symmetrical brain patterns seen in asphyxiated infants. Stroke often occurs long before birth. But a lack of oxygen in a term infant can also lead to stroke. This form of bleeding is thought to happen when blood vessels in the brain are not getting enough oxygen. The vessels then become brittle, making them prone to breakage. When the flow of blood returns to these brittle vessels, the pressure can cause them to rupture and bleed.

An experienced attorney working in conjunction with pediatric neurologists, neonatologists, and pediatric neuroradiologists can often determine the cause of a child’s brain injury. If you have been told by your physician that the cause of your baby’s brain injury cannot be determined, consulting an attorney with experience in handling obstetrical malpractice cases may be the first step in answering your questions.