Intrapartum Complications Associated With Malformations of Cortical Development

Maria Augusta Montenegro, MD, PhD; Fernando Cendes, MD, PhD; Helena Saito, MD; Jéssica G. Serra, MD; Camila F. Lopes, MD; Ana Maria S. Piovesana, MD, PhD; Helaine Milanez, MD, PhD; Marilisa M. Guerreiro, MD, PhD


J Child Neurol. 2005;20(8):675-678. 

In This Article


This study was conducted at the pediatric neurology clinic of our university hospital. From January 2000 to April 2004, we evaluated consecutive patients with developmental delay and diagnosis of malformation of cortical development confirmed by high-resolution magnetic resonance imaging (MRI). All patients were examined by at least one of us.

Inclusion criteria were age between 1 month and 18 years, diagnosis of malformation of cortical development established by high-resolution MRI, developmental delay or mental retardation, abnormal neurologic examination, and a signature of informed consent by parents or guardians. Exclusion criteria were genetic syndromes associated with facial dysmorphism and contraindication to perform MRI (eg, claustrophobia, metallic heart valve).

We used a semistructured questionnaire to ask parents about the occurrence of any intrapartum complication, such as sustained cyanosis, need for oxygen or ventilatory support, cardiopulmonary resuscitation, or prolonged intensive care unit care. We also assessed if there was any clue of abnormal fetal development during pregnancy—that is, reduced fetal movement—or if the patient was ever diagnosed as being asphyxiated at birth.

Because the occurrence of intrapartum complications was retrospectively assessed, we directly interviewed the patients' mothers and other available family members. We also reviewed the clinical files of all patients.

The data were compared with a disease control group of 50 children with idiopathic epilepsy (4 with benign childhood occipital epilepsy, 6 with absence epilepsy, 7 with juvenile myoclonic epilepsy, 7 with benign infantile epilepsy, and 26 with benign epilespy with centrotemporal spikes), with ages ranging from 1 to 18 years (mean 8.9 years). All patients in the control group had normal neuroimaging findings. Statistical analysis was performed using the chi-square test with the level of significance of .05.

MRI was performed in a 2.0 Tesla scanner (Elscint Prestige, Haifa, Israel), according to our epilepsy protocol: (1) sagittal T1-weighted spin echo, 6 mm thick (repetition time = 430 ms, echo time = 12 ms) for optimal orientation of the subsequent images; (2) coronal T1-weighted inversion recovery, 3 mm thick (flip angle = 200 degrees; repetition time = 2800 ms, echo time = 14 ms, inversion time TI = 840 ms, matrix = 130 × 256, field of view = 16 × 18 cm); (3) coronal T2-weighted fast spin echo, 3 to 4 mm thick (flip angle = 120 degrees; repetition time = 4800 ms, echo time = 129 ms, matrix = 252 × 320, field of view = 18 × 18 cm), (4) axial images parallel to the long axis of the hippocampi; T1-weighted gradient echo, 3 mm thick (flip angle = 70 degrees, repetition time = 200 ms, echo time = 5 ms, matrix = 180 × 232, field of view = 22 × 22 cm); (5) axial T2-weighted fast spin echo, 4 mm thick (flip angle = 120 degrees, repetition time = 6800 ms, echo time = 129 ms, matrix 252 × 328, field of view = 21 × 23 cm); (6) volumetric (three-dimensional) T1-weighted gradient echo, acquired in the sagittal plane for multiplanar reconstruction, 1 to 1.5 mm thick (flip angle = 35 degrees, repetition time = 22 ms, echo time = 9 ms, matrix = 256 × 220, field of view = 23 × 25 cm).


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