Several distributive patterns of hypoxic-ischemic cerebral injury have been recognized in asphyxiated newborns. Lesions of the brainstem have been rarely noted on magnetic resonance images in previous reports because they are difficult to detect. In this study, we demonstrate subtle but definite uniform symmetric brainstem lesions in children with perinatal brain injury. The areas of abnormal intensity were judged to comprise the central tegmental tract. The clinical manifestations in our patients were less severe than those previously described in patients with brainstem lesions. Two patients had difficulty of eye movement, but otherwise had no significant symptoms of brainstem cranial nerve nuclei involvement. All patients had lesions of white matter or cortex. Therefore, the abnormality in the dorsal brainstem revealed by magnetic resonance images is possibly as a result of secondary degeneration of the neurons that send axons into that tract.