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Hung YL, Shen CM, Hung KL, Hsieh WS. Lenticulostriate Vasculopathy in Very-Low-Birth-Weight Preterm Infants: A Longitudinal Cohort Study. CHILDREN 2021; 8:children8121166. [PMID: 34943361 PMCID: PMC8700389 DOI: 10.3390/children8121166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/05/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
Background: The pathogenesis and clinical significance of lenticulostriate vasculopathy (LSV) are unclear. Our study aimed to determine the prevalence, presentation, and evolution of LSV, and the perinatal risk factors associated with LSV among very-low-birth-weight (VLBW) preterm infants. Methods: One-hundred-and-thirty VLBW preterm infants were retrospectively enrolled in this study. Serial cranial ultrasound examinations were performed regularly from birth until a corrected age of 1 year. Infants with LSV were assigned to early-onset (≤10 postnatal days) and late-onset (>10 postnatal days) groups. Data describing the infants’ perinatal characteristics, placental histopathology, and neonatal morbidities were collected, and the groups were compared. Results: Of the VLBW infants, 39.2% had LSV before they were 1 year old. Linear-type LSV was the most common presentation, and >50% of the infants had bilateral involvement. LSV was first detected at 112 ± 83 postnatal days, and its detection timing correlated negatively with gestational age (GA) (R2 = 0.153, p = 0.005) and persisted for 6 months on average. The infants with and without LSV had similar perinatal characteristics, placental pathologies, cytomegalovirus infection rates, and clinical morbidities. The late-onset LSV group comprised 45 (88.2%) infants who had a significantly higher rate of being small for gestational age (SGA) and used oxygen for longer than the infants without LSV. After adjusting a multivariable regression model for GA and SGA, analysis showed that the duration of oxygen usage was an independent risk factor for late-onset LSV development in VLBW infants (odds ratio: 1.030, p = 0.032). Conclusion: LSV may be a nonspecific marker of perinatal insult to the developing brains of preterm infants. Prolonged postnatal oxygen usage may predispose VLBW preterm infants to late-onset LSV development. The long-term clinical impacts of LSV should be clarified.
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Affiliation(s)
- Yi-Li Hung
- Department of Pediatrics, Cathay General Hospital, Taipei 10630, Taiwan; (Y.-L.H.); (C.-M.S.)
- School of medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan;
| | - Chung-Min Shen
- Department of Pediatrics, Cathay General Hospital, Taipei 10630, Taiwan; (Y.-L.H.); (C.-M.S.)
- School of medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan;
| | - Kun-Long Hung
- School of medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan;
- Department of Pediatrics, Fu-Jen Catholic University Hospital, New Taipei City 243, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, Cathay General Hospital, Taipei 10630, Taiwan; (Y.-L.H.); (C.-M.S.)
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei 100, Taiwan
- Department of Pediatrics, National Taiwan University College of Medicine, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-2708-2121 (ext. 6565); Fax: +886-2-2314-7450
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Sisman J, Chalak L, Heyne R, Pritchard M, Weakley D, Brown LS, Rosenfeld CR. Lenticulostriate vasculopathy in preterm infants: a new classification, clinical associations and neurodevelopmental outcome. J Perinatol 2018; 38:1370-1378. [PMID: 30115968 DOI: 10.1038/s41372-018-0206-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 05/30/2018] [Accepted: 08/06/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the inter-rater reliability for the diagnosis of LSV on cranial ultrasound (cUS), determine the risk factors associated with LSV and its progression, and examine neurodevelopmental outcome. STUDY DESIGN Prospective case-control study of neonates ≤32wks of gestation assessed for LSV by serial cUS (n = 1351) between 2012 and 2014 and their neurodevelopment at 18-36mon-corrected age compared to controls. RESULTS Agreement for LSV on cUS improved from Κappa 0.4-0.7 after establishing definitive criteria and guidelines. BPD was the only variable associated with the occurrence and the progression of LSV. Cytomegalovirus (CMV) infection occurred in one neonate (1.5%). Neurodevelopmental outcome of neonates with LSV did not differ from controls. CONCLUSIONS Establishment of well-defined stages of LSV improves the reliability of the diagnosis and allows identification of neonates with progression of LSV. Although LSV was associated with BPD, it was not associated with congenital CMV infection.
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Affiliation(s)
- Julide Sisman
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Lina Chalak
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roy Heyne
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marcia Pritchard
- Department of Radiology, University of Texas Southwestern Medical Center and Children's Health System of Texas, Dallas, TX, USA
| | - Devri Weakley
- Department of Radiology, University of Texas Southwestern Medical Center and Children's Health System of Texas, Dallas, TX, USA
| | - L Steven Brown
- Department of Health System Research, Parkland Health and Hospital System, Dallas, TX, USA
| | - Charles R Rosenfeld
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Goraya JS, Berry S, Saggar K, Ahluwalia A. Stroke After Minor Head Trauma in Infants and Young Children With Basal Ganglia Calcification: A Lenticulostriate Vasculopathy? J Child Neurol 2018; 33:146-152. [PMID: 29334856 DOI: 10.1177/0883073817750501] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors retrospectively reviewed charts of the children with basal ganglia stroke who either had preceding minor head injury or showed basal ganglia calcification on computed tomography (CT) scan. Twenty children, 14 boys and 6 girls were identified. Eighteen were aged between 7 months to 17 months. Presentation was with hemiparesis in 17 and seizures in 3. Preceding minor head trauma was noted in 18. Family history was positive in 1 case. Bilateral basal ganglia calcification on CT scan was noted in 18. Brain magnetic resonance imaging done in 18 infants showed acute or chronic infarcts in basal ganglia. Results of other laboratory and radiological investigations were normal. Four infants were lost to follow-up, 9 achieved complete or nearly completely recovery, and 7 had persistent neurological deficits. Basal ganglia calcification likely represents mineralized lenticulostriate arteries, a marker of lenticulostriate vasculopathy. Abnormal lenticulostriate vessels are vulnerable to injury and thrombosis after minor head trauma resulting in stroke.
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Affiliation(s)
- Jatinder Singh Goraya
- 1 Department of Pediatrics, Division of Pediatric Neurology, Ludhiana, Punjab, India
| | - Shivankshi Berry
- 1 Department of Pediatrics, Division of Pediatric Neurology, Ludhiana, Punjab, India
| | - Kavita Saggar
- 2 Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Archana Ahluwalia
- 2 Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Giannattasio A, Di Costanzo P, Milite P, De Martino D, Capone E, Romano A, Bravaccio C, Capasso L, Raimondi F. Is lenticulostriated vasculopathy an unfavorable prognostic finding in infants with congenital cytomegalovirus infection? J Clin Virol 2017; 91:31-35. [PMID: 28412596 DOI: 10.1016/j.jcv.2017.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Lenticulostriated vasculopathy (LSV) detected in head ultrasound (HUS) has been related to neurological and hearing sequelae in infants with congenital cytomegalovirus (cCMV) infection. OBJECTIVE To assess the role of LSV in predicting neurodevelopmental and hearing outcomes in infants with cCMV infection. STUDY DESIGN We enrolled consecutive infants who were affected by cCMV infection and underwent HUS within the first month of life. Data on clinical onset and course, laboratory findings, visual/hearing functions and neurodevelopmental outcome were collected. As controls, infants with suspected intrauterine exposure to Toxoplasma and with no confirmed congenital toxoplasmosis were considered. RESULTS Data from 161 infants with cCMV infection (105 symptomatic) and 133 controls were analyzed. HUS was normal in 66 (41%) cCMV patients. Among these, 28 (42.4%) were symptomatic and 38 (57.6%) asymptomatic infants. The percentage of patients with no HUS abnormalities was higher in asymptomatic (38/56, 67.9%) than in symptomatic infants (28/105, 26.7%) (p<0.05). LSV, as isolated or associated with other brain abnormalities, was diagnosed in 64/161 (39.7%) patients with cCMV compared to 24/133 (18%) controls (p<0.05). In cCMV group, LSV was found in 51 (48.6%) symptomatic infants and in 13 (72.2%) asymptomatic patients (p>0.05). Overall, in the whole population of 95 patients with cCMV and abnormal HUS results, LSV (alone or with other findings) did not represent a risk factor for unfavorable neurological and hearing outcome. Similar results were obtained when we limited the analysis to the group of symptomatic cCMV patients. CONCLUSIONS Although LSV is a common HUS finding in infants with cCMV infection, its presence is not predictive of an adverse outcome. Our data suggest that HUS as a single neuroimaging investigation is unreliable in selecting candidates to antiviral therapy, mainly in presence of LSV as isolated finding.
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Affiliation(s)
- Antonietta Giannattasio
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy.
| | - Pasquale Di Costanzo
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Paola Milite
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Daniela De Martino
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Eleonora Capone
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Antonia Romano
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Carmela Bravaccio
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Letizia Capasso
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Francesco Raimondi
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
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Bilavsky E, Schwarz M, Pardo J, Attias J, Levy I, Haimi-Cohen Y, Amir J. Lenticulostriated vasculopathy is a high-risk marker for hearing loss in congenital cytomegalovirus infections. Acta Paediatr 2015; 104:e388-94. [PMID: 26018986 DOI: 10.1111/apa.13053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 03/17/2015] [Accepted: 05/21/2015] [Indexed: 11/29/2022]
Abstract
AIM This study investigated the relationship between lenticulostriated vasculopathy (LSV) and hearing loss in 141 infants with congenital cytomegalovirus (cCMV) infection. METHODS We included all infants with cCMV infection who were followed in our clinic for more than a year with only LSV signs of brain involvement on initial brain ultrasound. Group one comprised 13 infants with no hearing impairment at birth who were not treated with gan/valganciclovir during 2006-2009. Group two was 51 infants with LSV and no hearing impairment who had been treated since mid-2009. Group three was 25 infants born with LSV and hearing loss, who had been treated from birth. Group four was 52 control infants born during the same period with asymptomatic cCMV. Hearing tests were performed during the neonatal period and every four to six months until four years of age. RESULTS Hearing deterioration was more extensive in group one (85%) than in group two (0%, p < 0.001) and the asymptomatic group (10%, p < 0.001) and occurred more often in group four (10%) than in group two (0%, p = 0.008). CONCLUSION Lenticulostriated vasculopathy was common in infants with cCMV infection and may serve as a sign of central nervous system involvement and further hearing deterioration. Antiviral treatment may be prudent in such infants.
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Affiliation(s)
- Efraim Bilavsky
- Department of Pediatrics C; Schneider Children's Medical Center; Petah Tiqva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Michael Schwarz
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Pediatric Radiology; Schneider Children's Medical Center; Petah Tiqva Israel
| | - Joseph Pardo
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Gynecology and Obstetrics; Rabin Medical Center; Beilinson Hospital; Petah Tiqva Israel
| | - Joseph Attias
- Institute of Audiology and Clinical Neurophysiology; Schneider Children's Medical Center; Petah Tiqva Israel
- Department of Communication Sciences and Disorders; University of Haifa; Haifa Israel
| | - Itzhak Levy
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Infectious Diseases Unit; Schneider Children's Medical Center; Petah Tiqva Israel
| | - Yishai Haimi-Cohen
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Day Hospitalization Unit; Schneider Children's Medical Center; Petah Tiqva Israel
| | - Jacob Amir
- Department of Pediatrics C; Schneider Children's Medical Center; Petah Tiqva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Sisman J, Rosenfeld CR. Lenticulostriate vasculopathy in neonates: Is it a marker of cerebral insult? Critical review of the literature. Early Hum Dev 2015; 91:423-6. [PMID: 25939999 DOI: 10.1016/j.earlhumdev.2015.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 02/02/2023]
Abstract
Although lenticulostriate vasculopathy (LSV) was recognized nearly 30 years ago, neonatologists and radiologists still question its clinical significance. The diagnosis of LSV may be highly subjective, resulting in many false negatives when the radiologist is not familiar with the lesion or false positive if over-read by those with special interest in this finding. There has been an increase in incidence of LSV since its recognition in 1985 which might reflect nothing more than a growing awareness of this finding on neonatal cranial ultrasound. On the other hand, improved ultrasound imaging technology may have enhanced identification of LSV. Prospective studies evaluating the presence, significance and diagnosis of LSV are limited and have produced conflicting results. Therefore, the associated risk factors and clinical relevance of LSV on cranial ultrasound remain unclear. This review will examine the existing literature.
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Affiliation(s)
- Julide Sisman
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Charles R Rosenfeld
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Koral K, Sisman J, Pritchard M, Rosenfeld CR. Lenticulostriate vasculopathy in neonates: Perspective of the radiologist. Early Hum Dev 2015; 91:431-5. [PMID: 25940000 DOI: 10.1016/j.earlhumdev.2015.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 11/26/2022]
Abstract
Lenticulostriate vasculopathy (LSV) is a diagnosis dependent on neonatal cranial ultrasound (US). The diagnosis of LSV requires the presence of linear or branching echogenicities in the area of the basal ganglia and/or thalamus on gray scale cranial US. Although the diagnosis of LSV is dependent on cranial US, there are no convincing correlates observed on either computerized tomography or magnetic resonance imaging. Moreover, the radiographic criteria for LSV on cranial US remain vague, and intra-observer correlations are generally reported to be poor. The purpose of this review is to examine the issues associated with the use of cranial US and the diagnosis of LSV, including alternative imaging, clinical abnormalities and the significance of LSV on cranial US.
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Affiliation(s)
- Korgun Koral
- Department of Radiology, University of Texas Southwestern Medical Center and Children's Health System of Texas, United States
| | - Julide Sisman
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, United States.
| | - Marcia Pritchard
- Department of Radiology, University of Texas Southwestern Medical Center and Children's Health System of Texas, United States
| | - Charles R Rosenfeld
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, United States
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Cantey JB, Sisman J. The etiology of lenticulostriate vasculopathy and the role of congenital infections. Early Hum Dev 2015; 91:427-30. [PMID: 25960415 DOI: 10.1016/j.earlhumdev.2015.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 11/16/2022]
Abstract
Lenticulostriate vasculopathy (LSV) refers to increased echogenicity of the penetrating vessels that supply the basal ganglia and segments of the internal capsule seen on cranial ultrasound. Initially identified in infants with congenital infection, LSV has now been associated with a variety of infectious and non-infectious conditions. Although robust epidemiologic studies are lacking, the available evidence does not support broad evaluation for multiple congenital infections when LSV is identified. We propose screening infants with LSV for congenital cytomegalovirus infection and ensuring that prenatal screening included appropriate testing for syphilis, human immunodeficiency virus, and rubella-immune status. Large, prospective observational studies are needed to determine the incidence of LSV and the relative contribution of infectious and non-infectious conditions to LSV in the neonate.
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Affiliation(s)
- Joseph B Cantey
- Department of Pediatrics, Division of NeonatalPerinatal Medicine, University of Texas Southwestern Medical Center, United States; Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Texas Southwestern Medical Center, United States.
| | - Julide Sisman
- Department of Pediatrics, Division of NeonatalPerinatal Medicine, University of Texas Southwestern Medical Center, United States
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Shin HJ, Kim MJ, Lee HS, Namgung R, Park KI, Lee MJ. Imaging patterns of sonographic lenticulostriate vasculopathy and correlation with clinical and neurodevelopmental outcome. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:367-374. [PMID: 24975559 DOI: 10.1002/jcu.22196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/17/2014] [Accepted: 06/06/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To evaluate the relationship between the imaging patterns of lenticulostriate vasculopathy (LSV) and clinical outcomes. METHODS We performed cranial sonography (US) in 110 neonates and evaluated the patterns of visible lenticulostriate vessels with three grades: 0: no vessel seen; 1 (low grade): one or two thin branches seen; and 2 (high grade): more than three prominent branches seen. Color Doppler US was performed on these vessels to evaluate the presence of flow. Associated underlying diseases and the presence of neurodevelopmental delay on follow-up were reviewed retrospectively. RESULTS There were 51 neonates with associated underlying diseases, including congenital heart diseases (CHD) (n = 34) and neonatal hypoxia (n = 13). Sonographic LSV was detected in 29.1% cases (22 low- and 10 high-grade cases). Doppler flow was not detected in three patients with CHD (p = 0.028). CHD (odds ratio [OR], 25.73; p < 0.001), neonatal hypoxia (OR, 7.00; p = 0.020), two underlying diseases (OR, 73.232; p < 0.001), high-grade LSV (OR, 16.29; p = 0.005), and absent color Doppler flow (OR, 40.80; p = 0.046) were significantly associated with neurodevelopmental delay in univariate analysis. In multivariate analysis, underlying diseases and absent color Doppler flow were associated with neurodevelopmental delay. Both high LSV grade (area under the receiver operating characteristic curves of 0.901; 95% confidence interval, 0.823-0.979) and absent color Doppler flow (area under the receiver operating characteristic curves of 0.874; 95% confidence interval, 0.803-0.945) had a high predictive power for neurodevelopmental delay. CONCLUSIONS High-grade sonographic LSV and absent color Doppler flow on lenticulostriate vessels were significantly associated with neurodevelopmental delay.
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Affiliation(s)
- Hyun Joo Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Myung-Joon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Ran Namgung
- Department of Pediatrics, Severance Children's Hospital, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Kook In Park
- Department of Pediatrics, Severance Children's Hospital, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
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Sisman J, Logan JW, Westra SJ, Allred EN, Leviton A. Lenticulostriate vasculopathy in extremely low gestational age newborns: Inter-rater variability of cranial ultrasound readings, antecedents and postnatal characteristics. JOURNAL OF PEDIATRIC NEUROLOGY 2014; 12:183-193. [PMID: 25798046 DOI: 10.3233/jpn-140661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although lenticulostriate vasculopathy (LSV) was first detected on a cranial ultrasound nearly 30 years ago, its clinical implications and significance remain unknown. The objective of this study was to evaluate the inter-rater reliability of cranial ultrasound readings of LSV, and to explore relationships with potential antecedents and developmental correlates in extremely low gestational age newborns. Of the 1506 infants enrolled during the years 2002-2004, 1450 had at least one set of ultrasound scans evaluated for LSV and 939 had all three sets. To evaluate the inter-rater agreement for identifying LSV, we compared readings from two independent radiologists on days 1-4, 5-14, and on or after day 15. We then evaluated the relationships between LSV and maternal, antenatal, and postnatal characteristics. Our results showed that kappa values were 0.18, 0.33, and 0.36 on days 1-4, days 5-14, and day 15 or greater. Infants who were identified as LSV positive by two readers had higher Score for Neonatal Acute Physiology-II (an illness severity indicator), higher rates of tracheal infection and bacteremia, lower partial pressure of arterial oxygen and pH levels on 2 of the first 3 postnatal days, and they were more likely to have a lower psycho-motor development index at age 2 years. Positive agreement on the presence of LSV was low, as was the kappa value, an index of inter-rater reliability. Infants with high illness severity scores and their correlates were at increased risk of developing LSV, while those who develop LSV appear to be at increased risk of motor dysfunction.
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Affiliation(s)
- Julide Sisman
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - J Wells Logan
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Nationwide Children's Hospital, Columbus, OH, USA ; Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Ohio State University Medical Center, Columbus, OH, USA
| | - Sjirk J Westra
- Department of Radiology, Harvard Medical School, Boston, MA, USA ; Department of Radiology, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Elizabeth N Allred
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA ; Department of Neurology, Boston Children's Hospital, Boston, MA, USA ; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Alan Leviton
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA ; Department of Neurology, Harvard Medical School, Boston, MA, USA
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Lingappa L, Varma RD, Siddaiahgari S, Konanki R. Mineralizing angiopathy with infantile basal ganglia stroke after minor trauma. Dev Med Child Neurol 2014; 56:78-84. [PMID: 24102209 DOI: 10.1111/dmcn.12275] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/26/2022]
Abstract
AIMS The objective of this study was to describe a cohort of infants with basal ganglia stroke associated with mineralization in the lenticulostriate arteries and their clinical outcomes. METHOD Subcortical strokes occurring in infants during the study period were categorized as arterial ischaemic, venous, or haemorrhagic. A cohort of infants with basal ganglia infarcts and associated mineralization of lenticulostriate arteries were identified. This group was analysed for possible aetiological factors, clinical course, and recurrence rate of the stroke. RESULTS Of 23 infants with basal ganglia arterial ischaemic stroke, 22 (16 males, six females; mean age 11mo [±SD 4.8mo]) were found to have lenticulostriate artery mineralization. Twenty infants presented with hemiparesis and two presented with recurrent episodes of hemidystonia. Eighteen infants had a history of minor trauma before onset of stroke. No other predisposing factors were identified in this cohort. There were no demonstrable causes for vascular and soft tissue calcification. The mean follow-up was 11 months, during which five infants experienced stroke recurrence. Of the 17 infants who did not experience a recurrent stroke, eight exhibited complete neurological recovery, and nine had mild residual hemiparesis. INTERPRETATION Acute basal ganglia stroke after minor trauma associated with mineralization of lenticulostriate arteries in infants is a distinct clinicoradiological entity. Investigations for prothrombotic states and vasculopathies are normal. Although neurological outcomes in most children are good, trauma is a risk factor for recurrence of stroke.
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Affiliation(s)
- Lokesh Lingappa
- Department of Pediatric Neurology, Rainbow Hospital for Women and Children, Hyderabad, India
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Rios DR, Welty SE, Gunn JK, Beca J, Minard CG, Goldsworthy M, Coleman L, Hunter JV, Andropoulos DB, Shekerdemian LS. Usefulness of routine head ultrasound scans before surgery for congenital heart disease. Pediatrics 2013; 131:e1765-70. [PMID: 23690521 PMCID: PMC3666114 DOI: 10.1542/peds.2012-3734] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the utility of preoperative head ultrasound scan (HUS) in a cohort of newborns also undergoing preoperative MRI as part of a prospective research study of brain injury in infants having surgery for congenital heart disease (CHD). METHODS A total of 167 infants diagnosed with CHD were included in this 3-center study. None of the patients had clinical signs or symptoms of preoperative brain injury, and all patients received both HUS and brain MRI before undergoing surgical intervention. HUS and MRI results were reported by experienced neuroradiologists who were blinded to any specific clinical details of the study participants. The findings of the individual imaging modes were compared to evaluate for the presence of brain injury. RESULTS Preoperative brain injury was present on HUS in 5 infants (3%) and on MRI in 44 infants (26%) (P < .001). Four of the HUS showed intraventricular hemorrhage not seen on MRI, suggesting false-positive results, and the fifth showed periventricular leukomalacia. The predominant MRI abnormality was white matter injury (n = 32). Other findings included infarct (n = 16) and hemorrhage (n = 5). CONCLUSIONS Preoperative brain injury on MRI was present in 26% of infants with CHD, but only 3% had any evidence of brain injury on HUS. Among positive HUS, 80% were false-positive results. Our findings suggest that routine HUS is not indicated in asymptomatic term or near-term neonates undergoing surgery for CHD, and MRI may be a preferable tool when the assessment of these infants is warranted.
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Affiliation(s)
| | | | - Julia K. Gunn
- Department of Neonatology, The Royal Children’s Hospital and Murdoch Childrens Research Institute, Melbourne, Australia
| | - John Beca
- Department of Pediatric Intensive Care, Starship Children’s Hospital
| | - Charles G. Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas; and
| | | | - Lee Coleman
- Department of Radiology, The Royal Children’s Hospital Melbourne, Melbourne, Australia
| | | | - Dean B. Andropoulos
- Anesthesiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas
| | - Lara S. Shekerdemian
- Pediatrics, Section of Critical Care Medicine,,Address correspondence to Lara S. Shekerdemian, MD, Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital, 6621 Fannin St, Suite W6006, Houston, TX 77030. E-mail:
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Ancora G, Lanari M, Lazzarotto T, Venturi V, Tridapalli E, Sandri F, Menarini M, Ferretti E, Faldella G. Cranial ultrasound scanning and prediction of outcome in newborns with congenital cytomegalovirus infection. J Pediatr 2007; 150:157-61. [PMID: 17236893 DOI: 10.1016/j.jpeds.2006.11.032] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 09/16/2006] [Accepted: 11/03/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report the accuracy of ultrasound scanning (US) in predicting neurodevelopmental and sensorineural outcome in patients with congenital cytomegalovirus (CMV) infection. STUDY DESIGN Fifty-seven neonates with congenital CMV infection underwent brain US and were observed prospectively for motor skills, developmental quotient, and hearing function. RESULTS Abnormal results on US were found in 12 of 57 neonates. US lesions were more frequent in newborns with clinical and laboratory signs of congenital CMV infection at birth (10/18) than in newborns who had no symptoms at birth (2/39; P < .001). At least 1 sequela developed in all neonates with symptoms who had abnormal US results, whereas none of the neonates with symptoms who had normal US results had long-term sequelae (P < .001). In the population without symptoms, sensorineural hearing loss developed in 3 of 37 (8.1%) neonates with normal US results, whereas severe sequelae developed in 1 of 2 neonates with abnormal US results. CONCLUSIONS A good correlation was found between cerebral US abnormalities and the prediction of outcome in newborns who were congenitally infected with CMV and had symptoms at birth. US could be performed as the first neuroimaging study in these newborns. Data are insufficient to permit any suggestions for the population without symptoms.
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Affiliation(s)
- Gina Ancora
- Institute of Neonatology, Department of Gynecological, Obstetrical, and Pediatric Sciences, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.
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14
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Soghier LM, Vega M, Aref K, Reinersman GT, Koenigsberg M, Kogan M, Bello J, Romano J, Hoffman T, Brion LP. Diffuse basal ganglia or thalamus hyperechogenicity in preterm infants. J Perinatol 2006; 26:230-6. [PMID: 16496013 DOI: 10.1038/sj.jp.7211460] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the incidence and factors associated with diffuse basal ganglia or thalamus hyperechogenicity (BGTH) in preterm infants. STUDY DESIGN (1) Review of serial neurosonograms among neonates with gestational age (GA) <34 weeks born at Weiler Hospital during a 21-month period; (2) Color Doppler flow imaging; (3) Case-control study using GA group-matched controls; and (4) Blind reading of CT scans or MRIs in patients with BGTH. RESULTS Among 289 infants, 24 (8.3%) had diffuse BGTH. Color Doppler flow imaging was normal in nine patients. The incidence of diffuse BGTH was inversely related to GA (P<0.01). Logistic regression (n=96) showed that diffuse BGTH was significantly associated with requirement of high-frequency oscillation (HFO) (P=0.031), severe intraventricular hemorrhage (IVH) (P=0.004), hypotension requiring vasopressors (P=0.040), hypoglycemia (P=0.031) and male gender (P=0.014). Most patients with diffuse BGTH had normal basal ganglia and thalamus on CT/MRI, one had a hemorrhage, and one had an ischemic infarction. CONCLUSIONS In our series, diffuse BGTH occurred in 8.3%, and was associated with factors similar to those previously reported. In contrast, several series have reported almost exclusively linear or punctuate hyperechoic foci, corresponding to hyperechogenicity of the lenticulostriate vessels. Our data provide further evidence to suggest that diffuse BGTH and hyperechogenicity of the lenticulostriate vessels are two different entities. Additional studies are required to determine the long-term significance of diffuse BGTH.
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Affiliation(s)
- L M Soghier
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY 10461, USA
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Pezzati M, Giovannucci MLU, Filippi L, Dani C, Rubaltelli FF. Pericentric inversion of chromosome 2 and echogenic vasculature in the basal ganglia: a new finding? JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:146-148. [PMID: 15756662 DOI: 10.1002/jcu.20104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Linear branching echogenicities in the thalamus or basal ganglia have been reported in infants with several genetic and nongenetic disorders. In this article, we report 2 cases of newborns with a neurosonographic diagnosis of thalamic/basal ganglia vasculopathy and karyotype analysis showing pericentric inversion of chromosome 2. To our knowledge, there has been no previous mention of an association between these entities.
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Affiliation(s)
- Marco Pezzati
- Department of Critical Care Medicine, Section of Neonatology, University of Firenze, Careggi University Hospital, Viale Morgagni, 85-50134 Firenze, Italy
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Mittendorf R, Kuban K, Pryde PG, Gianopoulos JG, Yousefzadeh D. Antenatal risk factors associated with the development of lenticulostriate vasculopathy (LSV) in neonates. J Perinatol 2005; 25:101-7. [PMID: 15496867 DOI: 10.1038/sj.jp.7211212] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the antenatal risk factors associated with neonatal lenticulostriate vasculopathy (LSV). STUDY DESIGN Women in preterm labor were randomized to magnesium sulfate (MgSO4), other tocolytic, or saline control. The surviving babies underwent head ultrasounds (HUS) (weeks of life 1, 2, and 4) and periodic developmental examinations (months 4, 8, 12, and 18). RESULTS Of 140 infants, 17.1% (24) had neonatal intraventricular hemorrhage (IVH), and 10.0% (14) had LSV (half of the latter (7 of 14) had both IVH and LSV). In a regression model in which other risk factors were controlled for, the association between antenatal exposures to tocolytic MgSO4 >or=50 g and LSV were significant (adjusted odds ratio (OR), 8.3; 95% confidence interval (CI), 1.5 to 45.0; p=0.01). CONCLUSION Based on our data and their analyses, we infer that antenatal exposure to high-dosage, tocolytic MgSO4 may be associated with LSV.
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Affiliation(s)
- Robert Mittendorf
- Department of Obstetrics and Gynecology (R.M., J.G.G.), Loyola University Medical Center, Maywood, IL 60153, USA
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Mittendorf R, Covert R, Pryde PG, Lee KS, Ben-Ami T, Yousefzadeh D. Association between lenticulostriate vasculopathy (LSV) and neonatal intraventricular hemorrhage (IVH). J Perinatol 2004; 24:700-5. [PMID: 15254561 DOI: 10.1038/sj.jp.7211173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine whether there is an unconfounded association between neonatal intraventricular hemorrhage (IVH) and lenticulostriate vasculopathy (LSV (also known as thalamostriate or mineralizing vasculopathy)). STUDY DESIGN During the conduct of the Magnesium and Neurologic Endpoints Trial (MagNET), a randomized controlled trial involving maternal, hence fetal, exposure to antenatal magnesium sulfate in the context of preterm labor, head ultrasounds were obtained for each of the surviving neonates. Because of our previous experience in the diagnosis of LSV, when ascertaining the presence of IVH, as called for by the research protocol of our study, the presence or absence of LSV was also determined. RESULTS We found LSV to be relatively prevalent (10% (14 of 140) among surviving babies). More importantly, it was significantly associated with the occurrence of neonatal IVH, even when controlled for possible confounding (adjusted OR 9.8, 95% confidence interval 1.3 to 73.1; p=0.03). CONCLUSION Given the known relationships between IVH and neonatal morbidity and mortality, the finding of a statistically significant association between neonatal IVH and LSV may suggest more substantial implications for the latter than previously believed.
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Affiliation(s)
- Robert Mittendorf
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, IL 60153, USA
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El Ayoubi M, de Bethmann O, Firtion G, Monset-Couchard M. Devenir des enfants ayant présenté une vasculopathie lenticulostriée néonatale (70 cas). Arch Pediatr 2004; 11:18-23. [PMID: 14700755 DOI: 10.1016/j.arcped.2003.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES If the pattern of neonatal lenticulostriate vasculopathies (NLSV) is well-known, the prognosis is unknown except in TORCH syndromes. This study was aimed to describe the short, mid and long-term outcome of NLSV of various origins. POPULATION AND METHODS Of 9138 neonates (1981-2000) which were submitted to an early brain ultrasound study, 70 presented with a pattern of minor (35), moderate (27) or severe (8) NLSV, a single finding in 42 cases and in association with minor peri-intraventricular haemorrhage and/or leukomalacias in 28. The maternal and neonatal charts were reviewed, and the survivors were followed according to our usual policy. RESULTS Of nine deaths, eight cases included severe congenital defects (metabolic or malformations or acquired: transfused monochorial twins). Of 61 survivors, eight were lost to follow-up within the first year, 53 were followed for 21 months to 9 years and 7 months (median 4 years 5 months). Of 53 children, 35 (66%) were strictly normal, eight had minor deviations, four had moderate and six had major neurodevelopmental deficits. Of 34 survivors with isolated NLSV and known follow-up, 27 were normal (79%) versus 8/19 (42%) in associated NLSV. CONCLUSIONS Minor or moderate isolated NLSV generally have a good long-term prognosis. Associated forms of any severity depend mainly upon the severity of periventricular leukomalacias. Major forms of NLSV must be a warning sign of a possible underlying congenital anomaly which will rule the vital and functional prognosis.
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Affiliation(s)
- M El Ayoubi
- Service de médecine néonatale de Port-Royal, AP-HP, 123, boulevard de Port-Royal, 75679 Paris 14, France
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Wang HS, Kuo MF. Sonographic lenticulostriate vasculopathy in infancy with tic and other neuropsychiatric disorders developed after 7 to 9 years of follow-up. Brain Dev 2003; 25 Suppl 1:S43-7. [PMID: 14980372 DOI: 10.1016/s0387-7604(03)90008-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
On gray-scale transfontanel sonography, the small arteries supplying the basal ganglia are indistinct from the brain parenchyma in normal infants. Bright linear 'branched candlestick' stripes in these regions, suggesting sonographic lenticulostriate vasculopathy, were reported in more than 200 infants in the English literature; including 34 our own patients. To identify its long-term outcome, a prospective study was accomplished on our 34 infants with sonographic lenticulostriate vasculopathy which included 13 cryptogenic cases and 21 with distinct etiologies. At the age of 7 to 9 years in the cryptogenic group, 7 in 13 patients developed tics, attention deficits, hyperactivity, and/or obsession/compulsion; while in the symptomatic group only 2 of 21 patients had tics. The rate of mortality (33% vs. 0%), developmental delay (24% vs. 8%), mental retardation (24% vs. 0%), and neurologic deficits (29% vs. 0%) were significantly higher in the symptomatic group than the cryptogenic group. Comparatively, the occurrence rate of attention deficit-hyperactivity disorder (10% vs. 54%), tics (10% vs. 38%), and obsessive-compulsive disorder (5% vs. 13%) were significantly lower in the symptomatic group than the cryptogenic group. The rates of these neuropsychiatric disorders were 10% in the symptomatic group and 54% in the cryptogenic group. We concluded that idiopathic sonographic lenticulostriate vasculopathy in infancy may predict development of neuropsychiatric disorders later in childhood.
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Affiliation(s)
- Huei-Shyong Wang
- Division of (Pediatric) Neurology, Chang Gung Children's Hospital, Chang Gung University, Taiwan. wanghs@
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Makhoul IR, Eisenstein I, Sujov P, Soudack M, Smolkin T, Tamir A, Epelman M. Neonatal lenticulostriate vasculopathy: further characterisation. Arch Dis Child Fetal Neonatal Ed 2003; 88:F410-4. [PMID: 12937047 PMCID: PMC1721614 DOI: 10.1136/fn.88.5.f410] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lenticulostriate vasculopathy (LSV) is sometimes detected on routine brain ultrasonography in neonates, and is often associated with various perinatal and neonatal abnormalities. However, most reports on LSV are retrospective with no controls. OBJECTIVES To compare the perinatal and neonatal clinical characteristics of neonates with LSV with matched controls and to summarise all published reports of LSV. DESIGN A prospective study that summarises the clinical, laboratory, and neurosonographic data of neonates with LSV. METHODS Of 1184 neonates admitted to the neonatal intensive care unit (NICU) during a three year period, 857 had a routine head ultrasound examination. Twenty one had LSV, and were compared with 42 matched controls with regard to gestational, perinatal, neonatal, laboratory, and neurosonographic characteristics. RESULTS LSV was detected in 21 of the 857 (2.45%) neonates. It was bilateral in 10 of the 21 cases and located in the thalamus (n = 14) and basal ganglia (n = 7). Infants with LSV were not significantly different from matched controls in most tested variables. However, compared with the control group, the LSV group included significantly more multiple births and more disturbances in amniotic fluid volume, but less meconial amniotic fluid. In addition, the patients with LSV required fewer blood transfusions and less phototherapy. CONCLUSIONS Except for more multiple births, neonates with LSV did not display more adverse findings than their matched controls.
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Affiliation(s)
- I R Makhoul
- Department of Neonatology, Rambam Medical Center and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Hemachandra AH, Oravec D, Collin M, Tafari N, Mhanna MJ. Early and late postnatal identification of isolated lenticulostriate vasculopathy in preterm infants: associated findings. J Perinatol 2003; 23:20-3. [PMID: 12556922 DOI: 10.1038/sj.jp.7210861] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine the incidence, possible etiologies, and neurodevelopmental outcome of premature infants (<35 weeks) with isolated lenticulostriate vasculopathy (LSV). STUDY DESIGN In a retrospective case-control design, we reviewed the medical records of all premature infants who were admitted to our neonatal intensive care unit between 1996 and 2000. RESULTS The prevalence of LSV was 4.6% (21 of 453). Patients with late LSV (detected after 10 days of age) had less exposure than controls to prenatal steroids [42.8% (6 of 14) vs. 92.8% (13 of 14), respectively; p<0.01], and prenatal antibiotics [42.8% (6 of 14) vs. 85.7% (12 of 14), respectively; p=0.01]. Fifty-seven percent (8 of 14) of patients with late LSV had a low Apgar score vs. 14.2% (2 of 14) of the control group (p=0.01). Patients with LSV also had more muscle tone abnormalities than controls at 6 months of age [33.3% (5 of 15) vs. 5.2% (1 of 19), respectively; p=0.03]. CONCLUSION Patients with late LSV have less exposure to antenatal steroids and antibiotics, lower Apgar scores, and abnormal muscle tone at 6 months of age.
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Affiliation(s)
- A H Hemachandra
- Department of Pediatrics, The Cleveland Clinic Children's Hospital, OH, USA
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Kashman N, Kramer U, Stavorovsky Z, Shefer-Kaufmann N, Harel S, Mimouni FB, Dollberg S. Prognostic significance of hyperechogenic lesions in the basal ganglia and thalamus in neonates. J Child Neurol 2001; 16:591-4. [PMID: 11510931 DOI: 10.1177/088307380101600810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neonatal cranial ultrasonography at times reveals hyperechogenic lesions in the basal ganglia and thalamus. These lesions have been attributed to a wide variety of pathologic states, among them toxoplasmosis, rubella, cytomegalovirus, and herpes simplex (TORCH) infections, chromosomal abnormalities, and asphyxia. The clinical significance in terms of the neurodevelopmental outcome of this radiologic abnormality is unknown. We performed a developmental evaluation on 16 children aged 2 to 6 years in whom neonatal cranial ultrasonography had demonstrated hyperechogenic lesions in the basal ganglia or thalamus and had no other neurodevelopmental risk factors. There was no significant difference between the average Developmental Quotient of the target population and the normal population in regard to developmental status. We conclude that in our population, an isolated finding of hyperechogenic lesions in the basal ganglia is probably not a predictor of poor neurodevelopmental outcome.
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Affiliation(s)
- N Kashman
- Department of Internal Medicine, The Tel Aviv Sourasky Medical Center, Israel
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Bronshtein M, Zimmer EZ, Auslander R, Blazer S. Isolated hyperechogenic foci in the fetal thalamus in early pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 17:333-334. [PMID: 11339191 DOI: 10.1046/j.1469-0705.2001.00380.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To describe the sonographic features and outcome of fetuses with isolated hyperechogenic foci in the thalamic region. METHODS A detailed sonographic survey was performed in 46,244 consecutive pregnancies. Both low- and high-risk pregnancies were included. Transvaginal examinations were performed at 14-16 weeks' gestation, while transabdominal examinations were performed after 18 weeks' gestation. RESULTS Isolated hyperechogenic foci in the thalamic region were observed in seven fetuses. All cases were diagnosed at 14-16 weeks' gestation. Six fetuses had one hyperechogenic focus, and one fetus had two foci. The size of these foci ranged from 2-4 mm. A serologic work-up was negative in all these fetuses and their karyotype was normal. The hyperechogenic foci disappeared in mid-pregnancy in all cases, and fetuses were normal at delivery and on follow up to the age of 9 years. CONCLUSIONS Isolated hyperechogenic foci in the thalamic region in early pregnancy are probably benign in nature.
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Affiliation(s)
- M Bronshtein
- Departments of Obstetrics and Gynecology, Carmel Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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