The clinical, radiological and neuropathological features of selective hypoxic-ischemic injury of the brainstem with relative sparing of cortex and subcortical white matter in an asphyxiated term infant are described in a case reported from the Division of Neurology and Depts of Pediatrics, Pathology and Radiology, British Columbia’s Children’s Hospital, Vancouver, Canada. The infant was pale, flaccid and without respiratory effort at birth and seizures occurred during the first hour. The Apgar score was one at 1, 5 and 10 min. The signs of brainstem dysfunction included abnormal horizontal eye movements, facial diplegia and ptosis, tongue fasciculations, and abnormal auditory evoked potentials. CT showed increased attenuation in the basal ganglia at 2 wks, and dilation of the third ventricle at 1 mo. Lateral ventricles and cortical sulci were normal, showing no atrophy.
The infant died of pneumonia at 4 mo of age. Neuropathological examination revealed scarring and pallor of the thalamus, basal ganglia and brainstem with neuronal loss and gliosis. 
COMMENT. In animal studies, selective brainstem damage occurs after acute total asphyxia whereas the cerebral cortex and subcortical white matter are predominantly affected by prolonged partial asphyxia. In the human infant, the localization of hypoxic-ischemic encephalopathy is generally more diffuse  and selective brainstem injury is rare and frequently fatal.