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Tartarin H, Morotti A, Van Etten ES, Hausman-Kedem M, Charidimou A, Jouvent E, Susen S, Cordonnier C, Pasi M, Boulouis G. Uncommon Causes of Nontraumatic Intracerebral Hemorrhage. Stroke 2024; 55:1416-1427. [PMID: 38572651 DOI: 10.1161/strokeaha.123.043917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Nontraumatic intracerebral hemorrhage is an important health issue. Although common causes such as hypertension and cerebral amyloid angiopathy predominantly affect the elderly, there exists a spectrum of uncommon etiologies that contribute to the overall incidence of intracerebral hemorrhage. The identification of these rare causes is essential for targeted clinical management, informed prognostication, and strategic secondary prevention where relevant. This topical review explores the uncommon intracerebral hemorrhage causes and provides practical clues for their clinical and imaging identification. By expanding the clinician's differential diagnosis, this review aims to bridge the gap between standard intracerebral hemorrhage classification systems and the nuanced reality of clinical practice.
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Affiliation(s)
- Hugo Tartarin
- Diagnostic and Interventional Neuroradiology, University Hospital, Tours, France (H.T., G.B.)
| | - Andrea Morotti
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy (A.M.)
| | - Ellis S Van Etten
- Department of Neurology, Leiden University Medical Center, the Netherlands (E.S.V.E.)
| | - Moran Hausman-Kedem
- Pediatric Neurology Institute, Dana-Dewk Children's Hospital, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv Unisversity, Israel (M.H.-K.)
| | | | - Eric Jouvent
- Neurology Department, Lariboisière Hosp, APHP and Université Paris Cité, France (E.J.)
| | - Sophie Susen
- Hematology and Transfusion Department, Centre Hospitalier Universitaire de Lille, France (S.S.)
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience and Cognition, France (C.C.)
| | - Marco Pasi
- Stroke unit, CHU Tours, Centre Val de Loire, France (M.P.)
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology, University Hospital, Tours, France (H.T., G.B.)
- INSERM 1253 iBrain, Tours, Centre Val de Loire, France (G.B.)
- CIC-IT 14.15, Tours, Centre Val de Loire, France (G.B.)
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2
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Hadi E, Haddad L, Levy M, Gindes L, Hausman-Kedem M, Bassan H, Ben-Sira L, Libzon S, Kassif E, Hoffmann C, Leibovitz Z, Kasprian G, Lerman-Sagie T. Fetal intraventricular hemorrhage and periventricular hemorrhagic venous infarction: time for dedicated classification system. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024. [PMID: 38363592 DOI: 10.1002/uog.27613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Affiliation(s)
- E Hadi
- Diagnostic Ultrasound Unit, The Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Haddad
- Fetal Neurology Clinic, Wolfson Medical Center, Holon, Israel
- Ultrasound Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - M Levy
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - L Gindes
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Wolfson Medical Center, Holon, Israel
- Ultrasound Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - M Hausman-Kedem
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - H Bassan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology and Development Center, Shamir Medical Center (Assaf Harofeh), Be'er Ya'akov, Israel
| | - L Ben-Sira
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Division of Pediatric Radiology, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Libzon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Wolfson Medical Center, Holon, Israel
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - E Kassif
- Diagnostic Ultrasound Unit, The Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C Hoffmann
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuroradiology Unit, Department of Diagnostic Radiology, Sheba Medical Center, Ramat Gan, Israel
| | - Z Leibovitz
- Fetal Neurology Clinic, Wolfson Medical Center, Holon, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Obstetrics and Gynecology Ultrasound Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - G Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology, Medical University of Vienna, Vienna, Austria
| | - T Lerman-Sagie
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Wolfson Medical Center, Holon, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
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Ashwal E, Blaser S, Leckie A, Kajal D, Krishnan P, Chong K, Roifman M, Toi A, Chitayat D. Anterior extension of the choroid plexus into the frontal horns of the fetal lateral cerebral ventricles: Prenatal findings and postnatal outcome. Prenat Diagn 2023; 43:756-762. [PMID: 36946677 DOI: 10.1002/pd.6344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To evaluate the short- and long-term outcome of fetuses with evidence of extension of the choroid plexus into the frontal horns. METHODS This is a retrospective cohort study of fetuses diagnosed with isolated choroid plexi extending into the frontal horns. Fetuses with major central nervous system anomalies were excluded. Ultrasound and fetal/postnatal magnetic resonance imaging (MRI) were evaluated. Postnatal outcomes, including developmental assessment, were obtained. RESULTS Twenty nine fetuses were diagnosed with choroid plexus extension (22 unilateral and 7 bilateral). Gestational age at diagnosis was 19.3 weeks. Three cases (10.3%) presented with nonspecific extra-CNS findings. At presentation, 8/29 (28%) cases had single/multiple choroid plexus cysts (CPC). Twenty-six (89.6%) cases underwent antenatal MRI. On MRI, four cases had punctate susceptibility weighted imaging (SWI) foci suggesting trace hemosiderin and two cases had ventriculomegaly. Antenatal follow-up demonstrated resolution of the choroid plexus extension in 90% (18/20). Gestational age at delivery was 39.6 weeks. All had normal neurologic examinations within 24 h of life. Postnatal MRI studies were notable for deep venous differences in seven cases. Long-term clinical outcome was assessed in 14 cases with a median follow-up of 1.75 years, with normal neurodevelopment reported in 13/14 (92.8%). CONCLUSIONS Most fetuses with an anterior extension of the choroid plexus as the sole sonographic finding had favorable outcomes.
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Affiliation(s)
- Eran Ashwal
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Susan Blaser
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Division of Neuroradiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Leckie
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Dilkash Kajal
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Division of Neuroradiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karen Chong
- Department of Obstetrics and Gynecology, The Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Maian Roifman
- Department of Obstetrics and Gynecology, The Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ants Toi
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - David Chitayat
- Department of Obstetrics and Gynecology, The Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Ilves N, Pajusalu S, Kahre T, Laugesaar R, Šamarina U, Loorits D, Kool P, Ilves P. High Prevalence of Collagenopathies in Preterm- and Term-Born Children With Periventricular Venous Hemorrhagic Infarction. J Child Neurol 2023; 38:373-388. [PMID: 37427422 PMCID: PMC10467006 DOI: 10.1177/08830738231186233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/12/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate genetic risk factors in term-born children with antenatal periventricular hemorrhagic infarction (PVHI), presumed antenatal periventricular venous infarction and periventricular hemorrhagic infarction in preterm neonates. METHODS Genetic analysis and magnetic resonance imaging were performed in 85 children: term-born children (≥36 gestational weeks) with antenatal periventricular hemorrhagic infarction (n = 6) or presumed antenatal (n = 40) periventricular venous infarction and preterm children (<36 gestational weeks) with periventricular hemorrhagic infarction (n = 39). Genetic testing was performed using exome or large gene panel (n = 6700 genes) sequencing. RESULTS Pathogenic variants associated with stroke were found in 11 of 85 (12.9%) children with periventricular hemorrhagic infarction/periventricular venous infarction. Among the pathogenic variants, COL4A1/A2 and COL5A1 variants were found in 7 of 11 (63%) children. Additionally, 2 children had pathogenic variants associated with coagulopathy, whereas 2 other children had other variants associated with stroke. Children with collagenopathies had significantly more often bilateral multifocal stroke with severe white matter loss and diffuse hyperintensities in the white matter, moderate to severe hydrocephalus, moderate to severe decrease in size of the ipsilesional basal ganglia and thalamus compared to children with periventricular hemorrhagic infarction/periventricular venous infarction without genetic changes in the studied genes (P ≤ .01). Severe motor deficit and epilepsy developed more often in children with collagenopathies compared to children without genetic variants (P = .0013, odds ratio [OR] = 233, 95% confidence interval [CI]: 2.8-531; and P = .025, OR = 7.3, 95% CI: 1.3-41, respectively). CONCLUSIONS Children with periventricular hemorrhagic infarction/periventricular venous infarction have high prevalence of pathogenic variants in collagene genes (COL4A1/A2 and COL5A1). Genetic testing should be considered for all children with periventricular hemorrhagic infarction/periventricular venous infarction; COL4A1/A2 and COL5A1/A2 genes should be investigated first.
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Affiliation(s)
- Norman Ilves
- Radiology Clinic of Tartu University Hospital; Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Sander Pajusalu
- Department of Laboratory Genetics, Genetics and Personalized Medicine Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Genetics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Tiina Kahre
- Department of Laboratory Genetics, Genetics and Personalized Medicine Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Genetics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Rael Laugesaar
- Children's Clinic of Tartu University Hospital; Department of Pediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Ustina Šamarina
- Genetics and Personalized Medicine Clinic of Tartu University Hospital, Tartu, Estonia
| | - Dagmar Loorits
- Department of Radiology, Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Pille Kool
- Department of Radiology, Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Pilvi Ilves
- Radiology Clinic of Tartu University Hospital; Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
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Branyan K, Labelle-Dumais C, Wang X, Hayashi G, Lee B, Peltz Z, Gorman S, Li BQ, Mao M, Gould DB. Elevated TGFβ signaling contributes to cerebral small vessel disease in mouse models of Gould syndrome. Matrix Biol 2023; 115:48-70. [PMID: 36435425 PMCID: PMC10393528 DOI: 10.1016/j.matbio.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
Cerebral small vessel disease (CSVD) is a leading cause of stroke and vascular cognitive impairment and dementia. Studying monogenic CSVD can reveal pathways that are dysregulated in common sporadic forms of the disease and may represent therapeutic targets. Mutations in collagen type IV alpha 1 (COL4A1) and alpha 2 (COL4A2) cause highly penetrant CSVD as part of a multisystem disorder referred to as Gould syndrome. COL4A1 and COL4A2 form heterotrimers [a1α1α2(IV)] that are fundamental constituents of basement membranes. However, their functions are poorly understood and the mechanism(s) by which COL4A1 and COL4A2 mutations cause CSVD are unknown. We used histological, molecular, genetic, pharmacological, and in vivo imaging approaches to characterize central nervous system (CNS) vascular pathologies in Col4a1 mutant mouse models of monogenic CSVD to provide insight into underlying pathogenic mechanisms. We describe developmental CNS angiogenesis abnormalities characterized by impaired retinal vascular outgrowth and patterning, increased numbers of mural cells with abnormal morphologies, altered contractile protein expression in vascular smooth muscle cells (VSMCs) and age-related loss of arteriolar VSMCs in Col4a1 mutant mice. Importantly, we identified elevated TGFβ signaling as a pathogenic consequence of Col4a1 mutations and show that genetically suppressing TGFβ signaling ameliorated CNS vascular pathologies, including partial rescue of retinal vascular patterning defects, prevention of VSMC loss, and significant reduction of intracerebral hemorrhages in Col4a1 mutant mice aged up to 8 months. This study identifies a novel biological role for collagen α1α1α2(IV) as a regulator of TGFβ signaling and demonstrates that elevated TGFβ signaling contributes to CNS vascular pathologies caused by Col4a1 mutations. Our findings suggest that pharmacologically suppressing TGFβ signaling could reduce the severity of CSVD, and potentially other manifestations associated with Gould syndrome and have important translational implications that could extend to idiopathic forms of CSVD.
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Affiliation(s)
- Kayla Branyan
- Department of Ophthalmology, University of California, 555 Mission Bay Boulevard South, San Francisco, CA 94158, United States
| | - Cassandre Labelle-Dumais
- Department of Ophthalmology, University of California, 555 Mission Bay Boulevard South, San Francisco, CA 94158, United States
| | - Xiaowei Wang
- Department of Ophthalmology, University of California, 555 Mission Bay Boulevard South, San Francisco, CA 94158, United States
| | - Genki Hayashi
- Department of Ophthalmology, University of California, 555 Mission Bay Boulevard South, San Francisco, CA 94158, United States
| | - Bryson Lee
- Department of Ophthalmology, University of California, 555 Mission Bay Boulevard South, San Francisco, CA 94158, United States
| | - Zoe Peltz
- Department of Ophthalmology, University of California, 555 Mission Bay Boulevard South, San Francisco, CA 94158, United States
| | - Seán Gorman
- Department of Ophthalmology, University of California, 555 Mission Bay Boulevard South, San Francisco, CA 94158, United States
| | - Bo Qiao Li
- Department of Ophthalmology, University of California, 555 Mission Bay Boulevard South, San Francisco, CA 94158, United States
| | - Mao Mao
- Department of Ophthalmology, University of California, 555 Mission Bay Boulevard South, San Francisco, CA 94158, United States
| | - Douglas B Gould
- Department of Ophthalmology, University of California, 555 Mission Bay Boulevard South, San Francisco, CA 94158, United States; Department of Anatomy, Cardiovascular Research Institute, Bakar Aging Research Institute, and Institute for Human Genetics, University of California, San Francisco, United States.
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6
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Hausman-Kedem M, Herring R, Torres MD, Santoro JD, Kaseka ML, Vargas C, Amico G, Bertamino M, Nagesh D, Tilley J, Schenk A, Ben-Shachar S, Musolino PL. The Genetic Landscape of Ischemic Stroke in Children - Current Knowledge and Future Perspectives. Semin Pediatr Neurol 2022; 44:100999. [PMID: 36456039 DOI: 10.1016/j.spen.2022.100999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 11/18/2022]
Abstract
Stroke in childhood has multiple etiologies, which are mostly distinct from those in adults. Genetic discoveries over the last decade pointed to monogenic disorders as a rare but significant cause of ischemic stroke in children and young adults, including small vessel and arterial ischemic stroke. These discoveries contributed to the understanding that stroke in children may be a sign of an underlying genetic disease. The identification of these diseases requires a detailed medical and family history collection, a careful clinical evaluation for the detection of systemic symptoms and signs, and neuroimaging assessment. Establishing an accurate etiological diagnosis and understanding the genetic risk factors for stroke are essential steps to decipher the underlying mechanisms, optimize the design of tailored prevention strategies, and facilitate the identification of novel therapeutic targets in some cases. Despite the increasing recognition of monogenic causes of stroke, genetic disorders remain understudied and therefore under-recognized in children with stroke. Increased awareness among healthcare providers is essential to facilitate accurate diagnosis in a timely manner. In this review, we provide a summary of the main single-gene disorders which may present as ischemic stroke in childhood and describe their clinical manifestations. We provide a set of practical suggestions for the diagnostic work up of these uncommon causes of stroke, based upon the stroke subtype and imaging characteristics that may suggest a monogenic diagnosis of ischemic stroke in children. Current hurdles in the genetic analyses of children with ischemic stroke as well as future prospectives are discussed.
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Affiliation(s)
- Moran Hausman-Kedem
- Pediatric Neurology Institute, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Israel; The Sacker Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Rachelle Herring
- Neurology Department, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Marcela D Torres
- Hematology Department, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Jonathan D Santoro
- Division of Neurology, Children's Hospital Los Angeles, Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA USA
| | | | - Carolina Vargas
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Giulia Amico
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Bertamino
- Physical Medicine and Rehabilitation Unit, IRCCS Instituto Giannina Gaslini, Genoa, Italy
| | - Deepti Nagesh
- Division of Neurology, Children's Hospital Los Angeles, Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA USA
| | - Jo Tilley
- Departments of Hematology and Neurology, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Allyson Schenk
- Research Data Science and Analytics Department-Stroke and Thrombosis Program, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Shay Ben-Shachar
- Research Data Science and Analytics Department-Stroke and Thrombosis Program, Cook Children's Medical Center, Fort Worth, TX, USA; Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Patricia L Musolino
- Center for Genomic Medicine, Center for Rare Neurological Disorders, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Nizarudeen S, Shunmugavel GR. Multi-Layer ResNet-DenseNet architecture in consort with the XgBoost classifier for intracranial hemorrhage (ICH) subtype detection and classification. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2022. [DOI: 10.3233/jifs-221177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intracerebral haemorrhage (ICH) is defined as bleeding occurs in the brain and causes vascular abnormality, tumor, venous Infarction, therapeutic anticoagulation, trauma property, and cerebral aneurysm. It is a dangerous disease and increases high mortality rate within the age of 15 to 24. It may be cured by finding what type of ICH is affected in the brain within short period with more accuracy. The previous method did not provide adequate accuracy and increase the computational time. Therefore, in this manuscript Detection and Categorization of Acute Intracranial Hemorrhage (ICH) subtypes using a Multi-Layer DenseNet-ResNet Architecture with Improved Random Forest Classifier (IRF) is proposed to detect the subtypes of ICH with high accuracy, less computational time with maximal speed. Here, the brain CT images are collected from Physionet repository publicly dataset. Then the images are pre-processed to eliminate the noises. After that, the image features are extracted by using multi layer Densely Connected Convolutional Network (DenseNet) combined with Residual Network (ResNet) architecture with multiple Convolutional layers. The sub types of ICH (Epidural Hemorrhage (EDH), Subarachnoid Hemorrhage (SAH), Intracerebral Hemorrhage (ICH), Subdural Hemorrhage (SDH), Intraventricular Hemorrhage (IVH), normal is classified by using Improved Random Forest (IRF) Classifier with high accuracy. The simulation is activated in MATLAB platform. The proposed Multilayer-DenseNet-ResNet-IRF approach attains higher accuracy 23.44%, 31.93%, 42.83%, 41.9% compared with existing approaches, like Detection with classification of intracranial haemorrhage on CT images utilizing new deep-learning algorithm (ICH-DC-CNN), Detection with classification of intracranial haemorrhage on CT images utilizing new deep-learning algorithm (ICH-DC-CNN-ResNet-50), Shallow 3D CNN for detecting acute brain hemorrhage from medical imaging sensors (ICH-DC-S-3D-CNN), Convolutional neural network: a review of models, methods and applications to object detection (ICH-DC-CNN-AlexNet) respectively.
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Affiliation(s)
- Shanu Nizarudeen
- Department of Electronics and Communication Engineering, College of Engineering Karunagapally, Thodiyoor, Kollam, Karunagappalli, Kerala, India
| | - Ganesh R. Shunmugavel
- Department of Electronics and Communication Engineering, NICHE, Kumaracoil, Tamil Nadu, India
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8
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Xu M, Jin P, Huang Y, Qian Y, Lin M, Zuo J, Zhu J, Li Z, Dong M. Case report: Prenatal diagnosis of fetal intracranial hemorrhage due to compound mutations in the JAM3 gene. Front Genet 2022; 13:1036231. [PMID: 36339007 PMCID: PMC9629614 DOI: 10.3389/fgene.2022.1036231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
Intracranial hemorrhage is a common complication in preterm infants but occasionally occurs in fetuses. Disruptions of the genes, such as the COL4A1 and COL4A2 genes, are common genetic causes identified in fetal intracranial hemorrhage; however, the disruptions of the JAM3 gene are rarely reported. In the current investigation, fetal intracranial hemorrhage and dilated lateral ventricles were observed in three consecutive siblings in a pedigree. The pregnancies were terminated, and whole-exome sequencing, followed by Sanger sequencing, was performed on the affected fetuses. Pre-implantation genetic testing for monogenic diseases was performed to avoid the recurrence. The compound heterozygous variants of c.712 + 2T > A and c.813C > G p.Tyr271* in the JAM3 gene (NM_032801.4) were identified in the proband and its affected brother, which were predicted to be pathogenic. The variant of c.813C > G p.Tyr271* but not c.712 + 2T > A was identified in the fourth fetus, implying a good prognosis. Our findings expanded the spectrum of the pathogenic mutations in the JAM3 gene and revealed an important application of fetal whole-exome sequencing in idiopathic fetal intracranial hemorrhage.
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Affiliation(s)
- Min Xu
- Laboratory of Prenatal Diagnosis, Mindong Hospital Affiliated to Fujian Medical University, Ningde, China
| | - Pengzhen Jin
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yingzhi Huang
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yeqing Qian
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Miaochun Lin
- Laboratory of Prenatal Diagnosis, Mindong Hospital Affiliated to Fujian Medical University, Ningde, China
| | - Juan Zuo
- Laboratory of Prenatal Diagnosis, Mindong Hospital Affiliated to Fujian Medical University, Ningde, China
| | - Jin Zhu
- Laboratory of Prenatal Diagnosis, Mindong Hospital Affiliated to Fujian Medical University, Ningde, China
| | - Zhaohui Li
- Laboratory of Prenatal Diagnosis, Mindong Hospital Affiliated to Fujian Medical University, Ningde, China
- *Correspondence: Zhaohui Li, ; Minyue Dong,
| | - Minyue Dong
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Genetics, Ministry of Education, Hangzhou, China
- *Correspondence: Zhaohui Li, ; Minyue Dong,
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9
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Srivastava R, Mailo J, Dunbar M. Perinatal Stroke in Fetuses, Preterm and Term Infants. Semin Pediatr Neurol 2022; 43:100988. [PMID: 36344024 DOI: 10.1016/j.spen.2022.100988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/06/2022] [Accepted: 07/29/2022] [Indexed: 12/14/2022]
Abstract
Perinatal stroke is a well-defined heterogenous group of disorders involving a focal disruption of cerebral blood flow between 20 weeks gestation and 28 days of postnatal life. The most focused lifetime risk for stroke occurs during the first week after birth. The morbidity of perinatal stroke is high, as it is the most common cause of hemiparetic cerebral palsy which results in lifelong disability that becomes more apparent throughout childhood. Perinatal strokes can be classified by the timing of diagnosis (acute or retrospective), vessel involved (arterial or venous), and underlying cause (hemorrhagic or ischemic). Perinatal stroke has primarily been reported as a disorder of term infants; however, the preterm brain possesses different vulnerabilities that predispose an infant to stroke injury both in utero and after birth. Accurate diagnosis of perinatal stroke syndromes has important implications for investigations, management, and prognosis. The classification of perinatal stroke by age at presentation (fetal, preterm neonatal, term neonatal, and infancy/childhood) is summarized in this review, and includes detailed descriptions of risk factors, diagnosis, treatment, outcomes, controversies, and resources for family support.
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Affiliation(s)
- R Srivastava
- Division of Pediatric Neurology, Department of Pediatrics, University of Albertam, AB, Canada
| | - J Mailo
- Division of Pediatric Neurology, Department of Pediatrics, University of Albertam, AB, Canada
| | - M Dunbar
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada.
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10
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Abstract
Posthemorrhagic hydrocephalus of prematurity (PHHP) remains a vexing problem for patients, their families, and the healthcare system. The complexity of the pathogenesis of PHHP also presents a unique challenge within the fields of neonatology, neurology and neurosurgery. Here we focus on pathogenesis of PHHP and its impact on the development of CSF dynamics including choroid plexus, ependymal motile cilia and glymphatic system. PHHP is contrasted with infantile hydrocephalus from other etiologies, and with other types of posthemorrhagic hydrocephalus that occur later in life. The important concept that distinguishing ventricular volume from brain health and function is highlighted. The influence of the pathogenesis of PHHP on current interventions is reviewed, with particular emphasis on how the unique pathogenesis of PHHP contributes to the high rate of failure of current existing interventions. Finally, we discuss emerging interventions. A thorough understanding of the pathogenesis of PHHP is essential to developing effective non-surgical therapeutics to prevent the transformation from severe IVH to PHHP.
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Affiliation(s)
- Shenandoah Robinson
- Neonatal Intensive Care Nursery, John's Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States; Division of Pediatric Neurosurgery, Departments of Neurosurgery, Neurology and Pediatrics, Johns Hopkins University School of Medicine, Maryland, United States.
| | - Lauren L Jantzie
- Neonatal Intensive Care Nursery, John's Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States; Division of Neonatology, Departments of Pediatrics, Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Maryland, United States; Kennedy Krieger Institute, Maryland, United States
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11
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Sileo FG, Zöllner J, D'Antonio F, Islam S, Papageorghiou AT, Khalil A. Perinatal and long-term outcome of fetal intracranial hemorrhage: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:585-595. [PMID: 34529308 DOI: 10.1002/uog.24766] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/30/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Fetal intracranial hemorrhage (ICH) is associated with an increased risk of perinatal mortality and morbidity. Healthcare professionals often find it challenging to counsel parents due to its rarity and diverse presentation. The aim of this systematic review and meta-analysis was to investigate the perinatal outcome of fetuses with ICH. METHODS MEDLINE, EMBASE, ClinicalTrials.gov and The Cochrane Library databases were searched. Inclusion criteria were studies reporting the outcome of fetuses, newborns and infants diagnosed with ICH. The primary outcome was perinatal death (PND), defined as the sum of intrauterine (IUD) and neonatal death (NND). The secondary outcomes were stillbirth, NND, IUD, termination of pregnancy, need for surgery/shunting at birth, cerebral palsy (defined according to the European Cerebral Palsy Network and classified as diplegia, hemiplegia, quadriplegia, dyskinetic or mixed), neurodevelopmental delay and intact survival. All outcomes were explored in the included fetuses with ICH. A subgroup analysis according to the location of the hemorrhage (intra-axial and extra-axial) was also planned. Meta-analysis of proportions was used to combine data, and pooled proportions and their 95% CI were reported. RESULTS Sixteen studies (193 fetuses) were included in the meta-analysis. PND occurred in 14.6% (95% CI, 7.3-24.0%) of fetuses with ICH. Among liveborn cases, 27.6% (95% CI, 12.5-45.9%) required shunt placement or surgery after birth and 32.0% (95% CI, 22.2-42.6%) had cerebral palsy. Furthermore, 16.7% (95% CI, 8.4-27.2%) of cases had mild neurodevelopmental delay, while 31.1% (95% CI, 19.0-44.7%) experienced severe adverse neurodevelopmental outcome. Normal neurodevelopmental outcome was reported in 53.6% of fetuses. Subgroup analysis according to the location of ICH showed that PND occurred in 13.3% (95% CI, 5.7-23.4%) of fetuses with intra-axial bleeding and 26.7% (95% CI, 5.3-56.8%) of those with extra-axial bleeding. In fetuses with intra-axial hemorrhage, 25.2% (95% CI, 11.0-42.9%) required shunt placement or surgery after birth and 25.5% (95% CI, 15.3-37.2%) experienced cerebral palsy. In fetuses with intra-axial hemorrhage, mild and severe neurodevelopmental delay was observed in 14.9% (95% CI, 12.0-27.0%) and 32.8% (95% CI, 19.8-47.4%) of cases, respectively, while 53.2% (95% CI, 37.0-69.1%) experienced normal neurodevelopmental outcome. The incidence of mortality and postnatal neurodevelopmental outcome in fetuses with extra-axial hemorrhage could not be estimated reliably due to the small number of cases. CONCLUSIONS Fetuses with a prenatal diagnosis of ICH are at high risk of perinatal mortality and adverse neurodevelopmental outcome. Postnatal shunt placement or surgery was required in 28% of cases and cerebral palsy was diagnosed in approximately one-third of infants. Due to the rarity of ICH, multicenter prospective registries are warranted to collect high-quality data. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F G Sileo
- Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - J Zöllner
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - F D'Antonio
- Prenatal Medicine Unit, Obstetrics and Gynecology Unit, University "G. d'Annunzio" of Chieti, Chieti, Italy
| | - S Islam
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Twins Trust Centre for Research and Clinical Excellence, St George's Hospital, London, UK
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12
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Coste T, Vincent-Delorme C, Stichelbout M, Devisme L, Gelot A, Deryabin I, Pelluard F, Aloui C, Leutenegger AL, Jouannic JM, Héron D, Gould DB, Tournier-Lasserve E. COL4A1/COL4A2 and inherited platelet disorder gene variants in fetuses showing intracranial hemorrhage. Prenat Diagn 2022; 42:601-610. [PMID: 35150448 PMCID: PMC10434296 DOI: 10.1002/pd.6113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/12/2022] [Accepted: 02/09/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Variants of COL4A1/COL4A2 genes have been reported in fetal intracranial hemorrhage (ICH) cases but their prevalence and characteristics have not been established in a large series of fetuses. Fetal neonatal alloimmune thrombocytopenia is a major acquired ICH factor but the prevalence and characteristics of inherited platelet disorder (IPD) gene variants leading to thrombocytopenia are unknown. Herein, we screened COL4A1/COL4A2 and IPD genes in a large series of ICH fetuses. METHODS A cohort of 194 consecutive ICH fetuses were first screened for COL4A1/COL4A2 variants. We manually curated a list of 64 genes involved in IPD and investigated them in COL4A1/COL4A2 negative fetuses, using exome sequencing data from 101 of these fetuses. RESULT Pathogenic variants of COL4A1/COL4A2 genes were identified in 36 fetuses (19%). They occurred de novo in 70% of the 32 fetuses for whom parental DNA was available. Pathogenic variants in two megakaryopoiesis genes (MPL and MECOM genes) were identified in two families with recurrent and severe fetal ICH, with variable extraneurological pathological features. CONCLUSION Our study emphasizes the genetic heterogeneity of fetal ICH and the need to screen both COL4A1/COL4A2 and IPD genes in the etiological investigation of fetal ICH to allow proper genetic counseling.
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Affiliation(s)
- Thibault Coste
- AP-HP, Service de génétique moléculaire Neurovasculaire, Hôpital Saint-Louis, Paris, France
- Université de Paris, INSERM UMR-1141 Neurodiderot, Paris, France
| | | | | | | | - Antoinette Gelot
- APHP, Service de fœtopathologie, Hôpital Trousseau, Paris, France
| | - Igor Deryabin
- APHP, Service de fœtopathologie, Hôpital Trousseau, Paris, France
| | - Fanny Pelluard
- University Bordeaux, INSERM, BaRITOn, U1053, Bordeaux, France
| | - Chaker Aloui
- Université de Paris, INSERM UMR-1141 Neurodiderot, Paris, France
| | | | - Jean-Marie Jouannic
- APHP Sorbonne Université, Service de médecine fœtale, Hôpital Trousseau, Paris, France
| | - Delphine Héron
- AP-HP, Service de génétique clinique, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Douglas B Gould
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Elisabeth Tournier-Lasserve
- AP-HP, Service de génétique moléculaire Neurovasculaire, Hôpital Saint-Louis, Paris, France
- Université de Paris, INSERM UMR-1141 Neurodiderot, Paris, France
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13
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Wilson JL, Dowling M, Fullerton HJ. Stroke in Children. Stroke 2021; 52:3388-3390. [PMID: 34470487 DOI: 10.1161/strokeaha.121.033967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jenny L Wilson
- Pediatric Neurology, Oregon Health & Science University, Portland (J.L.W.)
| | - Michael Dowling
- Departments of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas (M.D.)
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, University of California, San Francisco (H.J.F.)
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