(From Govaert P, Vanhaesebrouch P, De Praeter C, Moens K, Leroy J. 36.10 ). (A–C) Lesions are identified by arrowheads. In this discussion, however, perinatal trauma refers to those adverse effects on the fetus during labor or delivery and in the neonatal period that, as noted earlier, appear to be caused primarily by mechanical factors. This relative rarity may relate to the fact that in the newborn the dura is unusually thick and largely contiguous with the inner periosteum. other high-energy collisions, and suffer ischemic stroke due to injury to the extracranial ca- rotid or vertebral arteries. If the lesion is at the midcervical level or higher, spasticity and hyperreflexia supervene in upper extremities as in lower extremities. A carotid endarterectomy consists of a small linear incision in the neck followed by dissection and localization of the carotid artery. Skull fracture, the principal bony lesion of the newborn, may be linear, be depressed, or consist of occipital osteodiastasis. 2–3) Many authors have reported that SEI with concomitant head injury is associated with high mortality rates. The prevalence differs from 23% 1 to 41%, 2 depending on the study population and definition of MEI. Carotid stenosis generally shows no symptoms until a complication occurs, such as a stroke or brain aneurysm occurs. 36.6B and 36.10A ). However, least elastic is the neonatal spinal cord, which is anchored above by the medulla and the roots of the brachial plexus and below by the cauda equina. The development of a leptomeningeal cyst over the weeks or months subsequent to fracture can be suspected at the bedside by the finding of increased transillumination of the affected region and defined in more detail by CT or MRI. Unfortunately such events often lead to criticism of obstetrical management. Hypotonia gives way to spasticity, and lower limbs may assume a position of triple flexion —that is, flexion of the hips, knees, and ankles. Thus specifically excluded are the disturbances of labor and delivery that lead principally to hypoxic-ischemic brain injury (see Chapter 17 , Chapter 18 , Chapter 19 , Chapter 20 ). (Understandably this lesion also is termed subaponeurotic hemorrhage.) First, stillbirth or rapid neonatal death with failure to establish adequate respiratory function occurs, particularly in cases with lesions involving the upper cervical cord, lower brain stem, or both. Changes in the upper extremities depend on the level of the lesion. The extracranial extension was better delineated with clear extension into the orbit, maxillary sinus, and invasion of the right pterygoid, masseter, and temporalis muscles (Figure 1). Traumatic injury to peripheral nervous system structures is particularly dominated by brachial plexus injury. Definition: pressure exerted by the tissues and fluids against an inelastic cranial vault, Term: measured ICP is composed of what? It should also be noted that in this study five additional patients with upper cervical lesions had no respiratory movements in the first days of life and had life support withdrawn at 4 to 10 days of age. In the largest series of such cases reported to date ( n = 14), 9 infants exhibited such signs. Signs of uncal herniation—for example, a fixed, dilated ipsilateral pupil—may occur. (From Saunders BS, Lazoritz S, McArtor RD, Marshall P, Bason WM. Extracranial Definition: on the exterior of the skull , outside the skull | Bedeutung, Aussprache, Übersetzungen und Beispiele Thus, although cesarean section for the fetus in breech position with hyperextended head is critically important, spinal cord injury may, uncommonly, already have occurred. The most widely cited neuropathological observations are those of Towbin, who concluded in the 1960s that spinal cord injury was a causal factor in approximately 10% of neonatal deaths. Although surgical evacuation has been the most common therapy, in one series three infants treated by aspiration of an accompanying cephalhematoma recovered without sequelae. Diffusion tensor MRI techniques show promise for the delineation of fiber tracts in the neonatal spinal cord. In the lower cervical–upper thoracic injury, the following neurological features are apparent to varying degrees in the first hours or days of life: flaccid weakness with areflexia of lower extremities and variable involvement of upper extremities (see subsequent discussion); sensory level in the region of the lower neck or upper trunk; respiratory disturbance with diaphragmatic breathing and paradoxical respiratory movements or even diaphragmatic paralysis; paralyzed abdominal muscles with a soft, sometimes bulging abdomen; atonic anal sphincter; and distended bladder that usually empties with gentle suprapubic pressure (see Table 36.4 ). ECG or echocardiographic signs, or both, of LV abnormalities were the most frequent abnormalities, and patients with cardiac injury experienced more RV than LV systolic dysfunction. CT or air myelography is generally not used now because of the superiority of MRI. Compression on the presenting part, exerted by the uterus or cervix, is the most common pathogenesis. In neonatal patients, approximately 90% of cases of brachial plexus injury involve the proximal upper limb and correspond to Erb palsy.