Abstract
In order to reveal whether or not brain impairment occurs in the human fetus during the intrauterine period, we described three term fetuses, having successful prenatal diagnosis of localized brain lesion, through the real-time ultrasound observation of in utero behavioral patterns. Movement of extremities, breathing movement, alternation of REM (rapid eye movement) and NREM (non-rapid eye movement) periods, and the concurrence of regular mouthing movement with the NREM period were used as parameters. Despite normal breathing movement patterns, in case 1, there were no movements observed in any of the four extremities, thereby suggesting impairment of the spinal cord at and below C5. This diagnosis was compatible with the neonatal MRI findings which showed a well circumscribed hyperintensity located at C5-6. In case 2, the repeated lack of breathing movement was noted, combined with the absence of alternation of the REM/NREM period, implying a lesion involved the pons and/or medulla oblongata. Our diagnosis was in good accordance with the actual neonatal CT findings, which showed a calcified lesion spreading from the pons to medulla oblongata. As for case 3, although movement of extremities, breathing movement and REM/NREM period alternation were all found to be within the normal range, there was no concurrence between regular mouthing and the NREM period. This suggested impairment of brain function responsible for NREM sleep, located from the pons through the thalamocortical connection to the cerebral hemisphere. Neonatal CT were found to be in agreement, by indicating a lesion, diffusely involving the cerebral white matter.
