Basal Ganglia, Thalamus, and Globus Pallidus Brain Injury

If a baby experiences severe asphyxia during birth, they may be diagnosed with hypoxic-ischemic encephalopathy, or HIE.

Parents may be told that their child has injuries to these areas of the brain: 

• basal ganglia
• Thalamus
• globus pallidus
• 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). When they’re damaged, the child can have a wide variety of motor disorders, such as cerebral palsy.

Different structures make up the brain, and each performs a specific task. The basal ganglia, located in the center of the brain, is a group of structures that are responsible for 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.

An injury to the basal ganglia can result in problems with sensory input or movement, such as: 

• Difficulty with balance or coordination
• Trouble with swallowing or speech
• Movement disorders like cerebral palsy
• Cognitive impairments

The thalamus is another structure located in the center of the brain. It is responsible for processing and sending signals for:

• sensory input
• movement
• thinking
• memory
• focus
• consciousness. 

If your baby’s brain injury involves damage to the thalamus, they may develop permanent physical disability, mental difficulties, or learning disabilities.

Lack of oxygen to the brain can cause brain injuries in babies. This injury is called birth asphyxia, or hypoxic-ischemic encephalopathy (HIE). Birth asphyxia usually occurs at or around the time of birth when a baby does not get enough oxygen. 

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. Complications during pregnancy or labor and delivery can stop or slow down the blood flow and harm the baby.

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.

Lack of oxygen to the brain can cause brain injuries in babies. This injury is called birth asphyxia, or hypoxic-ischemic encephalopathy (HIE). Birth asphyxia usually occurs at or around the time of birth when a baby does not get enough oxygen. 

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. Complications during pregnancy or labor and delivery can stop or slow down the blood flow and harm the baby.

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.

During labor and delivery, the baby is supposed to be closely monitored with a fetal heart rate monitor. If a baby becomes oxygen-deprived, the fetal heart monitor will show nonreassuring heart tracings. The medical team must then quickly deliver the baby to get them 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

The long-term effects of an infant’s brain injury mostly depend on two things: 

• The severity of injury
• The area of the brain the injury affects

Severe brain injury occurs when a baby is totally cut off from the oxygen supply. Conditions such as umbilical cord compression and placental abruption can cause this sudden loss of oxygen. If the lack of oxygen continues for a prolonged time, the injury becomes worse. 

Abrupt and severe oxygen deprivation causes acute near total asphyxia or near-total asphyxia.

 Acute profound asphyxia occurs when the baby experiences a loss of oxygen that is moderate to severe and lasts a prolonged time.

These types of birth asphyxia usually affect the deep gray matter or the deep structures of the brain, including:

• the basal ganglia
• thalamus
• brain stem.

Injuries to these areas of the brain lead to diagnoses including: 

• Impaired motor function
• Impaired cognitive function
• Motor disorders like cerebral palsy
• Intellectual or developmental disabilities

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

Partial prolonged asphyxia is a less dramatic interruption in blood flow. The blood flow and oxygen are diminished, not suddenly cut off. This type of oxygen deprivation usually lasts for more than 30 minutes. 

Partial prolonged asphyxia can be caused by:

• A partially compressed umbilical cord
• use of Pitocin and Cytotec during labor
• Prolonged or arrested labor.

When this type of oxygen deprivation occurs, the oxygenated blood in the brain is directed more towards the central, deep brain structures and away from the more superficial regions of the brain. Instead, outer areas, such as the cerebral cortex, white matter, tend to become damaged during partial prolonged asphyxia. For a comparison, think of how a tree’s trunk would stay healthy while the branches and leaves wilt. 

Partial prolonged asphyxia makes watershed areas of the brain vulnerable to damage. The brain receives blood from three major arteries. The watershed areas of the brain refer to regions on the borders of where those three arteries provide blood. When blood flow diminishes like in partial prolonged asphyxia, these watershed areas do not receive blood flow and become damaged. 

A child may experience partial prolonged asphyxia and have no movement problems. However, movement disorders such as cerebral palsy can occur with partial prolonged asphyxia, acute near total asphyxia and acute profound asphyxia.

Premature babies who experience birth asphyxia are susceptible to periventricular leukomalacia (PVL). 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.

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

Serial Scans: If a child has hypoxic-ischemic encephalopathy (HIE) or periventricular leukomalacia (PVL), the medical team should perform regular brain scans to assess how the brain injury is evolving. Brain scans, or serial scans, of the baby’s brain can give doctors important information about the nature of the child’s brain damage. 

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.

Additional Imaging (fMRI, DTI): 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. 

Regular Assessments and Evaluations: 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.

Missing Developmental Milestones: 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.

Difficult Delivery: 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.

Unfortunately, hospitals do make mistakes that can lead to a baby suffering from birth asphyxia and other serious conditions. 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

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. 

If you are seeking the help of a dedicated HIE lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. 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.

The birth injury and HIE lawyers at ABC Law Centers focus exclusively on birth injury cases. Most of our cases involve hypoxic-ischemic encephalopathy (HIE) and cerebral palsy. 

The 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, our team 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.