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DOCTOR'S HOUSE CALL
"Perinatal Lesion of Central Nervous System" - January, 2005
George Rogu, MD
is a native New Yorker. He was born and raised in Queens New York.
His family is originally from Romania and it was no surprise that he
obtained his medical degree from the University of Medicine at Bucharest, Romania.
Dr. Rogu completed his Pediatric training at Albert Einstein College of
Medicine, Montefiore Medical Center in New York. Since completing residency he has
been practicing general Pediatrics with RBK Pediatrics in Long Island New York.
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We were just referred a 7 month old boy that was born at 35-36 weeks. The medical report we received says that the neurologist
diagnosed him as having "perinatal lesion of central nervous system." In June and August, the notation "early recovery period" was on
the report. In October, the notation was "late recovery period."
Is "perinatal lesion of CNS" something that you frequently see? How concerned should we be?
This is an excellent question because it is found all too commonly on many of the medical reports. I have also personally found that many
adoptive parents access the internet for most of their adoptive information. It is well know that this is a common diagnosis and that most of
the children do very well and do not have a neurological problem. It is because of this internet buzz that many parents and agencies just
dismiss this diagnosis without a medical evaluation. Obviously, if a child has this diagnosis and is walking, running and normal developmental
milestones on the video, chances are really good that this child will have a good neurological outcome.
While at first glance one would worry about this diagnosis because it sounds as if the child may have suffered insult to the brain.
Most intelligent people obviously are concerned about future neurological damage. According to Russian medical teaching, this diagnosis is
given to an infant who had anything out of the ordinary that may have a future impact on the infant’s brain development. It does not necessarily
mean that the infant has brain damage. The diagnosis can be made on the behalf of the mother with something as common as no prenatal care,
or on behalf of the infants status such as prematurity, abnormal laboratory testing or jaundice.
All that it really means is that this infant is a high risk infant and it needs to be closely observed for problems during the first year of life. It does
not necessarily mean that every infant will have a poor neurological outcome. This is obvious since most of the children that have this diagnosis
are actually very normal.
Below I am attaching a accurate translation of this diagnosis in a Russian text book. As you will see, that many of the things listed especially
on the behalf of the mother will trigger this diagnosis, especially if the child is left in an orphanage. Such common issues are No prenatal care,
lack of medical history, chronic health conditions of the mother. Most children that are abandoned in an orphanage, there is a lack of medical
information on the mother, hence making this a higher risk infant. I think that this is why this diagnosis is so very common.
Perinatal (prenatal) encephalopathy: (Variably translated "perinatal lesion or affectation of the central nervous system," "encephalopathia," and
many others.) One or more risk factors present in me history of the mother or the baby which may allow for a poor neurological outcome.
(see the table that follows.) There may be mild neurological impairment in the infant.
Perintal (prenatal) encephalopathy:
Maternal factors
:
Lack of known medical history, alcohol or cigarette use, No prenatal care, Anemia
Past miscarriages, abortions or premature delivery, Young or old maternal age, High number pregnancy,
Chronic health problems, Infections, Poor social situation, Difficult or complicated delivery,
Abnormal placenta
Infant factors:
Low Apgar scores, Abnormal muscle tone or reflexes, Jaundice, Seizures, Irritability or depression,
Tremor, Poor suck, feeding problems, Abnormal head circumference, Congenital abnormalities
Genetic conditions, Abnormal ultrasound of brain or other parts of body, Intrauterine or perinatal infections,
Prematurity, Abnormal prenatal growth, Abnormal laboratory tests,
Perinatal trauma (affectation) of the central nervous system: Synonym for perinatal encephalopathy. Also called perinatal lesion,
cranio-cerebal trauma of the newborn and other variations
Stage of condition: The progression of a disease
1) Recuperation or rehabilitation: Improving but still requiring treatment.
2) Residual: Almost recovered but signs or symptoms not completely resolved, expected to be healthy. Also used for late or
permanent results such as scar or stroke.
3) Recovery period: Condition or illness completely resolved.
4) Compensated: Abnormal but stable.
5) Subcompensated: Abnormal, clinically unstable, may deteriorate.
Logistically interpreting the limited information given about this child, the diagnosis was given because of the slight prematurity. A couple
of months later, he was categorized as being in the Early Recovery period, they thought that the child was doing good and then in the late
recovery period: Condition or illness completely resolved.
I am really fortunate to see many children that have this diagnosis listed on their medical, yet after I see them in the U.S.A most of these
children do very very well.
Addendum:
The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation
and or problem. If your child has a specific problem you need to ask your pediatrician about it -- only after a careful history and physical exam
can a medical diagnosis and treatment plan be made.
* Please note: This work product is subject to copyright and may not be reprinted
without permission of The Welcome Garden and it's author. Contributors have agreed that the written product may remain onsite permanently,
in accordance with our policies.
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