Basal Ganglia, Thalamus, and Globus Pallidus Brain Injury

As a parent, learning that your baby was diagnosed with a brain injury from birth can be devastating. The brain is responsible for our everyday functions, especially certain brain structures like the basal ganglia and thalamus. You might wonder how the brain injury will affect them as they grow and what the severity of their impairment will look like. You may also question what led to your baby’s injury. 

If your baby was diagnosed with a basal ganglia, thalamus, or globus pallidus brain injury, they may have serious permanent disabilities as a result.

The brain is made up of different structures that each perform a specific task. The basal ganglia, which is located in the center of the brain, is a group of structures that are responsible for our motor function, or movement. The basal ganglia connects to different parts of our brains and sends signals through them that control our muscle movements. The globus pallidus is a major component of the basal ganglia and is involved in the regulation of voluntary movement. If your baby has a brain injury that affects the basal ganglia or globus pallidus, they may have a motor control disorder as a result.

The thalamus is another structure located in the center of the brain. It is responsible for processing and sending signals for sensory and motor information. However, it also plays a part in our thinking, memory, focus, and consciousness. If your baby’s brain injury involves damage to the thalamus, they may develop permanent physical disability and/or mental difficulties or learning disabilities.

A common cause of brain injury in babies is a lack of oxygen to the brain, called birth asphyxia, or hypoxic-ischemic encephalopathy (HIE). Birth asphyxia occurs at or around the time of birth when something affects the amount of oxygen that the baby receives. When the baby is in the womb, it receives all of its oxygen from the mother. This oxygen travels through blood vessels that connect between the uterus and placenta. The blood then travels to the baby through the umbilical cord. Anything that stops or slows down this flow of oxygen-rich blood can cause birth asphyxia and result in an HIE diagnosis.

The long-term effects of birth asphyxia and HIE are serious and can include motor disorders like cerebral palsy, intellectual and developmental disabilities, and other serious lifelong conditions. These serious conditions can be associated with basal ganglia, thalami, and globus pallidus injury.

Birth asphyxia is usually caused by a problem with the uterus, placenta, or umbilical cord. Severe asphyxia and HIE often cause injury to the basal ganglia, globus pallidus, thalamus, and brain stem.

Common causes of birth asphyxia & hypoxic-ischemic encephalopathy (HIE) include:

• Failure to quickly deliver a baby in the presence of oxygen deprivation (delayed emergency C-section)
• Umbilical cord problems, such as a nuchal cord (cord wrapped around baby’s neck), umbilical cord prolapse, short umbilical cord, and cord in a true knot
• Ruptured uterus
• Placental abruption (placenta separates from uterine wall (womb))
• Preeclampsia / eclampsia
• Placenta previa
• Oligohydramnios (low amniotic fluid)
• Premature rupture of the membranes (PROM) / premature birth
• Prolonged and arrested labor
• Uterine tachysystole caused by Pitocin and Cytotec
• Fetal stroke
• Postmaturity syndrome

Even if you didn’t face one of these complications, you may still have the right to pursue a legal claim for your baby’s injuries. Unfortunately, birth asphyxia can be caused by many different or coinciding conditions and complications. These are a few common examples, and are not meant to be a complete list.

The Long-Term Effects of an Infant’s Brain Injury Mostly Depend on the Area and Severity of the Brain Injury

1. Acute Near Total Asphyxia / Acute Profound Asphyxia

When a baby is severely or totally cut off from the oxygen supply, it is called acute near total asphyxia or acute profound asphyxia. Conditions such as umbilical cord compression and placental abruption can cause near-total and total asphyxia, as well as acute profound asphyxia.

Abrupt and severe oxygen deprivation causes near-total or total asphyxia. Acute profound asphyxia occurs when the baby experiences asphyxia that is moderate to severe and relatively prolonged. These types of birth asphyxia usually affect the deep gray matter or the deep structures of the brain, which include the basal ganglia, thalamus and brain stem.

Research shows that injury in the deep gray matter (deep gray nuclei) is associated with severely impaired motor function and cognitive function. Motor function impairments typically lead to diagnoses of motor disorders such as cerebral palsy, which are disorders that cause a child to have problems with movement. Cognitive impairments often result in diagnoses of intellectual or developmental disabilities.

Babies with a basal ganglia-thalamus pattern of injury have the most severe encephalopathy (brain injury). This pattern involves the deep gray nuclei and part of the cortex; the brain injury extends to the total cortex when severe.

2. Partial Prolonged Asphyxia

Partial prolonged asphyxia is a less dramatic interruption in blood flow. This type of oxygen deprivation usually lasts for more than 30 minutes. A partially compressed umbilical cord and use of Pitocin and Cytotec during labor can cause partial prolonged asphyxia.

Due to the body’s compensatory mechanisms, when this type of oxygen deprivation occurs, blood in the brain is directed more towards the central, deep brain structures and away from the more superficial regions of the brain. Thus, outer areas, such as the cerebral cortex and white matter tend to become damaged during partial prolonged asphyxia. Indeed, the watershed and parasagittal regions of the brain are particularly vulnerable because they do not have a direct arterial blood supply. When the watershed pattern of injury is severe, it extends to the cortical gray matter. Injuries in the white matter portion of the brain typically result in cognitive impairments that often occur without functional motor deficits (movement problems). In fact, injuries to outer areas of gray matter, such as that in the cerebral cortex, also may leave the child without any motor impairment. Thus, a child may experience partial prolonged asphyxia and have no movement problems. Of course, movement disorders such as cerebral palsy can occur with partial prolonged asphyxia, acute near total asphyxia and acute profound asphyxia.

As discussed, premature babies who experience birth asphyxia are susceptible to periventricular leukomalacia. When a baby has PVL, the injury is often seen in the watershed zones in the periventricular region. When a baby has hypoxic-ischemic encephalopathy, hypoxic-ischemic lesions and other evidence of brain damage are seen on brain scans (although the full extent of injury may take weeks). Depending on the nature of the birth asphyxia and the condition of the baby, lesions can be in many different parts of the brain, such as the basal ganglia and periventricular white matter.

3. Mixed Brain Injury Pattern

Babies can experience partial prolonged asphyxia in addition to acute types of asphyxia, resulting in a mixed brain injury pattern.

During labor and delivery, the baby is supposed to be closely monitored with a fetal heart rate monitor. If a baby becomes oxygen-deprived, it will be reflected on the fetal heart monitor as nonreassuring heart tracings. When nonreassuring tracings occur, the medical team must quickly deliver the baby to get him or her out of the oxygen depriving conditions. Failure to quickly deliver a baby experiencing birth asphyxia can cause brain damage in important structures such as the basal ganglia, globus pallidus, thalamus, and cerebral cortex.

Birth asphyxia and HIE can cause permanent brain damage, leaving children with long-term conditions such as:

• Cerebral palsy
• Seizure disorders
• Developmental delays
• Intellectual (cognitive) disabilities
• Motor disorders
• Learning disabilities
• Speech delays and disorders

When a baby experiences severe asphyxia during birth and is diagnosed with HIE, parents are often told that their child has basal ganglia, thalamus, globus pallidus, or sensorimotor cortex injury. These “deep” brain structures and types of brain injury involve the gray matter of the brain. Gray matter is brain tissue responsible for normal, everyday functions.

The basal ganglia are gray matter structures that are located just underneath the cerebral cortex, on both sides of the thalamus. These structures play a central role in motor function (movement), and when they’re damaged, the child can have a wide variety of motor disorders, such as cerebral palsy.

What Are the Long-Term Effects of Basal Ganglia Brain Injury, Hypoxic Ischemic Encephalopathy (HIE) and Periventricular Leukomalacia (PVL)?

If a child has hypoxic-ischemic encephalopathy (HIE) or periventricular leukomalacia (PVL), the medical team should perform regular brain scans (known as serial scans) to assess how the brain injury is evolving. Serial scans of the baby’ brain can give doctors important information about the nature of the child’s brain damage. Sometimes the medical team fails to recognize that a baby has a brain injury and brain scans are not performed. When this happens, parents may not notice problems until the child begins to miss important developmental milestones around the age of five or six.

In some cases, brain injury—especially mild injury affecting the white matter—may not be evident on basic brain scans, such as an MRI. More sophisticated techniques may need to be used, such as a functional MRI (fMRI) or diffuse tensor imaging (DTI). These tend to be more costly and certain hospitals may not readily perform them. Neuropsychological assessments are often used to determine how a brain injury is impacting a child’s ability to function. These evaluations assess mood and personality as well as skills such as language and problem-solving.

Images of a baby’s brain can help doctors determine the severity of the brain injury and what problems, if any, the child may face long-term. Of course, since brain injury is a progression, the full extent of damage may not be apparent for many weeks after the initial oxygen-depriving insult.

It is critical for the medical team to closely monitor babies after birth for signs of infant brain injury, especially if the baby had a difficult delivery; birth asphyxia usually occurs during labor and delivery. Conditions such as the cord being wrapped around the baby’s neck (nuchal cord), umbilical cord prolapse and placental abruption can cause a lack of oxygen to the baby’s brain and birth asphyxia.

Cerebral palsy (CP) is a group of motor disorders often caused by damage to the motor centers of the brain, such as the basal ganglia, thalamus, and globus pallidus. Children with cerebral palsy have certain limitations in motor function, and some of them may also experience other serious conditions, such as seizures.

Damage to the basal ganglia and globus pallidus affects the brain’s ability to control muscle movement and coordination. This type of injury is associated with dyskinetic or athetoid cerebral palsy, which causes involuntary movements. According to the Cleveland Clinic, athetoid cerebral palsy is “the second most common type of cerebral palsy.”

It is also associated with brain damage caused by kernicterus. When a baby has elevated bilirubin levels (jaundice) for too long, the bilirubin can enter the brain and cause a form of brain damage called kernicterus. Bilirubin is toxic to the brain. When kernicterus occurs, although other areas can sustain injury, there is often bilateral globus pallidus injury, which means that both parts of the globus pallidus show damage. In turn, this globus pallidus injury can lead to athetoid cerebral palsy.

What Causes Birth Asphyxia, Basal Ganglia Brain Injury, Hypoxic Ischemic Encephalopathy (HIE) & Periventricular Leukomalacia (PVL)?

In the womb, a fetus receives oxygen through the umbilical cord. Oxygen-rich blood travels from the mother through the placenta and then to the baby through a vein in the umbilical cord. Anything that affects this flow of blood can decrease the baby’s oxygenation. Thus, if the mother’s blood pressure drops or there are problems with the uterus (womb), placenta, or umbilical cord, the baby may experience birth asphyxia. In certain cases, such as a complete placental abruption or umbilical cord compression, the baby can be completely deprived of oxygen-rich blood and will then have to rely on fetal reserves. These events are obstetrical emergencies and the baby must be delivered right away before the oxygen deprivation starts to cause brain injuries such as hypoxic-ischemic encephalopathy and periventricular leukomalacia.

Unfortunately, hospitals do make mistakes that can lead to a baby suffering from birth asphyxia and other serious conditions as outlined above. If these errors are preventable and they end up permanently injuring or disabling a child, it is considered medical malpractice. If your child suffered from a preventable brain injury that involved the basal ganglia, thalamus, globus pallidus, or other critical areas, it is worth discovering whether their injury was created by a medical error.

If you believe your medical providers acted negligently during your labor or delivery, it can be overwhelming to consider pursuing a lawsuit after what you endured. Parenting a child with special needs can be a full-time job, and overcoming any trauma from birth can also be emotionally taxing. A dedicated birth injury lawyer can take the burden off your shoulders and help you receive the compensation you need to properly care for your child.

The benefits of a successful birth injury case can include:

• Recovering financial compensation to use towards your child’s special care needs 
• Seeking complementary and alternative therapies for your child
• Securing adaptive equipment for your child to use for more independence
• Knowing your child will have finances and care even after you are gone
• Having a support team that can answer your questions about birth injury
• Finding new opportunities to support and advocate for your child

This by no means a complete list – each family is different and has different needs. It’s important to know what your legal options are so you feel empowered to make the best decision for your child. 

Award-Winning Michigan HIE Lawyers Helping Children with Birth Injuries

If you are seeking the help of a Michigan HIE lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers: Birth Injury Lawyers is a national birth injury law firm that has been helping children with hypoxic-ischemic encephalopathy and other birth injuries exclusively since 1997.

Birth injury and HIE lawyer Jesse Reiter, president of ABC Law Centers: Birth Injury Lawyers, has been focusing exclusively on birth injury cases for his entire career, and most of his cases involve hypoxic-ischemic encephalopathy (HIE) and cerebral palsy. Partners Jesse Reiter and Rebecca Walsh are currently recognized as two of the best medical malpractice lawyers in America by U.S. News and World Report, a publication that also recognized Reiter & Walsh, P.C. as one of the best medical malpractice law firms in the United States. The Michigan HIE lawyers at ABC Law Centers: Birth Injury Lawyers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).

If your child was diagnosed with a birth injury, such as cerebral palsy, hypoxic-ischemic encephalopathy (HIE), or a seizure disorder, the award-winning Michigan HIE lawyers at ABC Law Centers: Birth Injury Lawyers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy, and a secure future, and we give personal attention to each child and family we represent.