4 -  Degrees of severity
The experiments on total asphyxia at birth in fact
produced a Wernicke-like pattern of brain damage,
but damage of the inferior colliculi was not compared
by Windle (1969) or Myers (1972) to Wernicke’s
encephalopathy [1, 2].  Perhaps the involvement of
the inferior colliculi caused by experimental asphyxia
was too dramatic.  The damage in Wernicke's
encephalopathy whether by chronic alcohol
intoxication or thiamine deficiency is caused by
vasodilation and engorgement of blood vessels that
rupture in petechial (or as described in the German
literature flea-bite size) hemorrhages [3].  See figure
xx.

In their first report, Ranck and Windle (1959) made
special note that damage to the inferior colliculi and
other subcortical areas was not hemorrhagic [4].  
Thus comparison with Wernicke's encephalopathy
likely was considered.

Neither chronic intoxication nor thiamine deficiency is
normally as catastrophic as the kind of total asphyxia
inflicted by Windle and Myers.  However, Vortmeyer et
al (1992) observed massive hemorrhagic damage of
the inferior colliculi in a patient on parenteral feeding
lacking in thiamine supplement [5].  The picture of
damage to the inferior colliculi in one of the cases
reported by Vortmeyer et al. is as dramatic as those
published by Windle and Myers.  See figure xx.

Chen et al (1997) found the inferior colliculi sustained
damage before the mammillary bodies or any other of
the brainstem nuclei of high metabolic rate in
laboratory rats injected with pyrithiamine [6], a poison
that displaces thiamine from its binding sites on
aerobic enzymes [7].

Wernicke-like patterns of brainstem damage have
been reported as the aftermath of trauma and
asphyxia at birth in several human cases [8-15].  As
noted in chapter xx (section xx), all of these reports
describe, and include pictures of, prominent damage
in the inferior colliculi.  Figure xx in chapter xx is a
photograph from the paper by Leech and Alvord and
shows visible damage of the inferior colliculi [13].  
These reports of brainstem damage found in cases of
neonatal death are discussed further in the next
chapter.

References

1. Windle WF (1969a) Brain
   damage by asphyxia at birth.
   
2. Myers RE (1972) Two
   patterns of perinatal brain
   damage and their conditions
   of occurrence.
   
3. Kant F (1933) Die
   Pseudoencephalitis
   Wernicke der Alkoholiker.
   (polio-encephalitis
   haemorrhagica superior
   acuta).
   
4. Ranck JB, Windle WF (1959).
   Brain damage in the monkey,
   Macaca mulatta, by asphyxia
   neonatorum.
   
5. Vortmeyer AO  et al. (1992)
   Haemorrhagic thiamine
   deficient encephalopathy
   following prolonged
   parenteral nutrition.
   
6. Chen Q, et al. (1997)
   Causality of parenchymal
   and vascular changes in rats
   with experimental thiamine
   deficiency encephalopathy.
   
7. Troncoso JC et al. (1981)
   Model of Wernicke's
   encephalopathy.
   
8. Norman MG (1972) Antenatal
   neuronal loss and gliosis of
   the reticular formation,
   thalamus, and
   hypothalamus.  A report of
   three cases.
   
9. Griffiths AD, Laurence KM
   (1974) The effect of hypoxia
   and hypoglycemia on the
   brain of the newborn human
   infant.
   
10. Grunnet ML et al. (1974)
    Brain changes in newborns
    from an intensive care unit.  
    
11. Schneider H et al. (1975)
    Anoxic fcencephalopathy with
    predominant involvement of
    basal ganglia, brain stem,
    and spinal cord in the
    perinatal period.
    
12. Smith JF, Rodeck C (1975)
    Multiple cystic and focal
    encephalomalacia in infancy
    and childhood with brain
    stem damage.
    
13. Leech RW, Alvord EC (1977)
    Anoxic-ischemic
    encephalopathy in the
    human neonatal period, the
    significance of brain stem
    involvement.  Archives of
    Neurology 34:109-113.
    
14. Roland EH et al. (1988)
    Selective brainstem injury in
    an asphyxiated newborn.
    
15. Natsume J et al. (1995)
    Clinical, neurophysiologic,
    and neuropathological
    features of an infant with
    brain damage of total
    asphyxia type (Myers).  .
    

Full References

top

1. Windle WF (1969a) Brain damage by asphyxia at birth.  Scientific American 221(#4):76-
   84.
   
2. Myers RE (1972) Two patterns of perinatal brain damage and their conditions of
   occurrence.  American Journal of Obstetrics and Gynecology 112:246-276.
   
3. Kant F (1933) Die Pseudoencephalitis Wernicke der Alkoholiker. (polio-encephalitis
   haemorrhagica superior acuta).  Archiv für Psychiatrie und Nervenkrankheiten 98:702-
   768.
   
4. Ranck JB, Windle WF (1959). Brain damage in the monkey, Macaca mulatta, by
   asphyxia neonatorum.  Experimental Neurology 1:130-154.
   
5. Vortmeyer AO, Hagel C, Laas R (1992) Haemorrhagic thiamine deficient
   encephalopathy following prolonged parenteral nutrition. Journal of Neurology,
   Neurosurgery and Psychiatry 55:826-829.
   
6. Chen Q, Okada S, Okeda R (1997) Causality of parenchymal and vascular changes in
   rats with experimental thiamine deficiency encephalopathy. Pathology International 47:
   748-756
   
7. Troncoso JC, Johnston MV, Hess KM, Griffin JW, Price DL (1981) Model of Wernicke's
   encephalopathy. Archives Of Neurology 38:350-354.
   
8. Norman MG (1972) Antenatal neuronal loss and gliosis of the reticular formation,
   thalamus, and hypothalamus.  A report of three cases.  Neurology (Minneapolis) 22:
   910-916.
   
9. Griffiths AD, Laurence KM (1974) The effect of hypoxia and hypoglycemia on the brain of
   the newborn human infant.  Developmental Medicine and Child Neurology 16:308-319.
   
10. Grunnet ML, Curless RG, Bray PF, Jung AL (1974) Brain changes in newborns from an
    intensive care unit.  Developmental Medicine and Child Neurology 16:320-328.
    
11. Schneider H, Ballowitz L, Schachinger H, Hanefield F, Droeszus J-U (1975) Anoxic
    fcencephalopathy with predominant involvement of basal ganglia, brain stem, and
    spinal cord in the perinatal period.  Acta Neuropathologica (Berlin) 32:287-298.
    
12. Smith JF, Rodeck C (1975) Multiple cystic and focal encephalomalacia in infancy and
    childhood with brain stem damage. Journal of the neurological sciences 25:377-88
    
13. Leech RW, Alvord EC (1977) Anoxic-ischemic encephalopathy in the human neonatal
    period, the significance of brain stem involvement.  Archives of Neurology 34:109-113.
    
14. Roland EH, Hill A, Norman MG, Flodmark O, MacNab AJ (1988) Selective brainstem
    injury in an asphyxiated newborn.  Annals of Neurology 23:89-92.
    
15. Natsume J, Watanabe K, Kuno K, Hayakawa F, Hashizume Y (1995) Clinical,
    neurophysiologic, and neuropathological features of an infant with brain damage of
    total asphyxia type (Myers).  Pediatric Neurology 13:61-64.