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Govaert P, Arena R, Dudink J, Steggerda S, Agut T, Marissens G, Hoebeek F. Developmental anatomy of the thalamus, perinatal lesions, and neurological development. Dev Med Child Neurol 2024. [PMID: 38875159 DOI: 10.1111/dmcn.15992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Abstract
The thalamic nuclei develop before a viable preterm age. GABAergic neuronal migration is especially active in the third trimester. Thalamic axons meet cortical axons during subplate activation and create the definitive cortical plate in the second and third trimesters. Default higher-order cortical driver connections to the thalamus are then replaced by the maturing sensory networks, in a process that is driven by first-order thalamic neurons. Surface electroencephalographic activity, generated first in the subplate and later in the cortical plate, gradually show oscillations based on the interaction of the cortex with thalamus, which is controlled by the thalamic reticular nucleus. In viable newborn infants, in addition to sensorimotor networks, the thalamus already contributes to visual, auditory, and pain processing, and to arousal and sleep. Isolated thalamic lesions may present as clinical seizures. In addition to asphyxia and stroke, infection and network injury are also common. Cranial ultrasound can be used to classify neonatal thalamic injuries based on functional parcelling of the mature thalamus. We provide ample illustration and a detailed description of the impact of neonatal focal thalamic injury on neurological development, and discuss the potential for neuroprotection based on thalamocortical plasticity.
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Affiliation(s)
- Paul Govaert
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | - Roberta Arena
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | - Jeroen Dudink
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | | | - Thais Agut
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | | | - Freek Hoebeek
- Department for Developmental Origins of Disease/Brain Centre, Division Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Watanabe Y, Odaka M, Motoi H, Oyama Y, Shiga K, Ito S. Neurological prognostic factors for human herpes virus 6/7-associated acute encephalopathy in children: A single-center study. Brain Dev 2023; 45:102-109. [PMID: 36503814 DOI: 10.1016/j.braindev.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 11/21/2022]
Abstract
AIM To identify prognostic factors for severe neurological sequelae and epileptic seizures in children with human herpes virus (HHV) 6/7-associated acute encephalopathy (AE). METHODS We retrospectively studied pediatric cases of HHV6/7-associated AE between April 2011 and March 2021. Neurological sequelae were assessed using the Pediatric Cerebral Performance Category scale (PCPC) and the presence of epileptic seizures 1 year after onset. We investigated the prognostic factors between the non-severe sequelae group (PCPC scores ≤ 2) and severe sequelae group (PCPC scores ≥ 3) in patients without severe neurological complications before onset. RESULTS Forty patients, ranging from 4 to 95 months old, were included. AE with biphasic seizures and late reduced diffusion were the most common types of encephalopathy (n = 28). Among the 36 patients evaluated neurological sequelae, 17, nine, eight, and two were categorized as PCPC 1, 2, 3 and 4, respectively. Epileptic seizures were observed in nine patients. In the severe sequelae group, significantly more cases with coma in the acute phase and thalamic lesions on MRI and higher serum aspartate aminotransferase, alanine aminotransferase (ALT), and lactate dehydrogenase levels were observed. Multivariate analysis showed a significant between-group difference in the rate of coma (p = 0.0405). Patients with epileptic seizures had a higher rate of coma and thalamic lesions and higher serum ALT and urinary beta 2-microglobulin levels, but there was no significant difference in the multivariate analysis. CONCLUSIONS In HHV6/7-associated AE, coma was a significant prognostic factor for severe neurological sequelae.
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Affiliation(s)
- Yoshihiro Watanabe
- Children's Medical Center, Yokohama City University Medical Center, Yokohama, Japan.
| | - Mao Odaka
- Children's Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hirotaka Motoi
- Children's Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshitaka Oyama
- Children's Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kentaro Shiga
- Children's Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Kim S, Sohn SI, Park H, Kim J, Hong JH. Characteristic Magnetic Resonance Image Features of Acute Network Injury in Young Patients. Case Rep Neurol 2021; 13:628-633. [PMID: 34720965 PMCID: PMC8543319 DOI: 10.1159/000518726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/20/2021] [Indexed: 11/25/2022] Open
Abstract
Cerebral infarction is known to cause secondary degeneration of the areas connected to the primarily damaged regions. This has been named as acute network injury and is usually recognized in newborns or babies by high signal intensity on diffusion-weighted imaging (DWI). In this article, we present 2 cases demonstrating several characteristics of network injury. Some features are comparable to previous studies and others are distinctive to our cases. The patients not only showed secondary injury in the thorough pyramidal tract along the longitudinal extensions of neural tracts as expected but also followed transverse connections to reach the contralateral hemisphere. The location of network injury varied according to the initial lesion and projected in an omnidirectional manner as long as the brain parts are interconnected. In addition, the cases well demonstrated the temporal changes on brain imaging. Network injury appeared on DWI around a week after major damage and then subsequently disappeared. The overall process of appearance to disappearance was completed within 2 weeks from the symptom onset. As ominous neurological outcomes are thought to be related to acute network injuries, a comprehensive understanding of the phenomenon is pivotal in improving diagnosis and management.
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Affiliation(s)
- Sohyeon Kim
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Sung-Il Sohn
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Hyungjong Park
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - JoonSik Kim
- Department of Pediatrics, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jeong-Ho Hong
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
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Aida N. 1H-MR Spectroscopy of the Early Developmental Brain, Neonatal Encephalopathies, and Neurometabolic Disorders. Magn Reson Med Sci 2021; 21:9-28. [PMID: 34421092 PMCID: PMC9199977 DOI: 10.2463/mrms.rev.2021-0055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
MRI interpretations of the pediatric brain are often challenging for general radiologists and clinicians because MR signals and morphology are continuously changing in the developing brain. Furthermore, the developing brain reacts differently to injuries, resulting in imaging characteristics that differ from those of the mature brain. Proton magnetic resonance spectroscopy (1H-MRS) is a non-invasive method for assessing neurological abnormalities at the microscopic level and measures in vivo brain metabolites using a clinical MR machine. In MR examinations of the pediatric brain, 1H-MRS demonstrates its powerful diagnostic capability when MRI is insufficient for diagnostic features. MRI and 1H-MRS may be complementary tools for diagnosing and monitoring diseases. However, there is currently no consensus on how to include 1H-MRS in clinical MR examinations. An overview of the clinical implementation of 1H-MRS for the assessment of early pediatric developmental brains as well as the diagnosis, prognostification, and disease monitoring of various non-neoplastic brain disorders, including neonatal encephalopathies and neurometabolic/neurodegenerative diseases, was provided herein. Qualitative and quantitative 1H-MRS is a powerful non-invasive tool for accessing various brain metabolites to confirm age appropriate peaks and detect abnormal peaks or deficient or reduced peaks, which may facilitate the identification of metabolic and neurodegenerative disorders as well as damage associated with hypoxic-ischemic encephalopathy (HIE). Moreover, 1H-MRS has potential as a biomarker for monitoring therapeutic efficacy in metabolic diseases and neonatal HIE. It also provides insights into the pathophysiologies of various disorders, which may facilitate the use of novel therapeutic approaches. Therefore, 1H-MRS needs to be included more frequently in routine clinical MR examinations of pediatric patients with neurological disorders.
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Affiliation(s)
- Noriko Aida
- Department of Radiology, Kanagawa Children's Medical Center.,Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine
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Fluss J, Dinomais M, Chabrier S. Perinatal stroke syndromes: Similarities and diversities in aetiology, outcome and management. Eur J Paediatr Neurol 2019; 23:368-383. [PMID: 30879961 DOI: 10.1016/j.ejpn.2019.02.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/04/2019] [Accepted: 02/24/2019] [Indexed: 01/09/2023]
Abstract
With a birth-prevalence of 37-67/100,000 (mostly term-born), perinatal stroke encompasses distinct disease-states with diverse causality, mechanism, time of onset, mode of presentation and outcome. Neonatal primary haemorrhagic stroke and ischemic events (also divided into neonatal arterial ischemic stroke and neonatal cerebral sinus venous thrombosis) that manifest soon after birth are distinguished from presumed perinatal - ischemic or haemorrhagic - stroke. Signs of the latter become apparent only beyond the neonatal period, most often with motor asymmetry or milestones delay, and occasionally with seizures. Acute or remote MRI defines the type of stroke and is useful for prognosis. Acute care relies on homeostatic maintenance. Seizures are often self-limited and anticonvulsant agents might be discontinued before discharge. Prolonged anticoagulation for a few weeks is an option in some cases of sinovenous thrombosis. Although the risk of severe impairment is low, many children develop mild to moderate multimodal developmental issues that require a multidisciplinary approach.
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Affiliation(s)
- Joel Fluss
- Pediatric Neurology Unit, Geneva Children's Hospital, 6 rue Willy-Donzé, 1211 Genève 4, Switzerland
| | - Mickaël Dinomais
- CHU Angers, Département de Médecine Physique et de Réadaptation, CHU Angers-Capucins, F-49933, Angers, France; Université d'Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) EA7315, F-49000, Angers, France
| | - Stéphane Chabrier
- CHU Saint-Étienne, French Centre for Paediatric Stroke, Paediatric Physical and Rehabilitation Medicine Department, INSERM, CIC 1408, F-42055, Saint-Étienne, France; INSERM, U1059 Sainbiose, Univ Saint-Étienne, Univ Lyon, F-42023, Saint-Étienne, France.
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Fluss J, Garcia-Tarodo S, Granier M, Villega F, Ferey S, Husson B, Kossorotoff M, Muehlethaler V, Lebon S, Chabrier S. Perinatal arterial ischemic stroke related to carotid artery occlusion. Eur J Paediatr Neurol 2016; 20:639-48. [PMID: 27025300 DOI: 10.1016/j.ejpn.2016.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/02/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aetiology of perinatal arterial ischemic stroke remains speculative. It is however widely accepted that the aetiology is multifactorial, involving various maternal, placental, foetal and neonatal risk factors. A resulting thromboembolic process is hypothesized and the placenta identified as the most plausible source. An arteriopathy, as observed in a significant proportion of childhood ischemic stroke, is thought to be rare. METHODS We report here five cases of perinatal stroke that differ from the vast majority by documented carotid occlusion, and add eleven other similar cases from the literature. RESULTS In the majority, an intraluminal thrombus of placental origin is the most probable hypothesis, while in the remaining ones, one can reasonably presume a direct vessel wall injury related to a traumatic delivery, yet generally unproven by imaging. CONCLUSION We hypothesize that most of these cases share similar pathophysiology with the more common perinatal arterial ischemic stroke but differ by a persistent identified thrombus in the carotid artery at the time of first imaging, leading to a more severe and extended ischemic damage responsible for an adverse neurological outcome.
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Affiliation(s)
- Joel Fluss
- Pediatric Neurology Unit, Pediatric Subspecialities Service, Children's Hospital, Geneva University Hospitals, Switzerland.
| | - Stephanie Garcia-Tarodo
- Pediatric Neurology Unit, Pediatric Subspecialities Service, Children's Hospital, Geneva University Hospitals, Switzerland
| | - Michèle Granier
- Neonatal Unit, Sud-Francilien Hospital Centre, Corbeil, France
| | - Frédéric Villega
- Pediatric Neurology, Children's Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Solène Ferey
- Unit of Pediatric Radiology, Children's Hospital, Geneva University Hospitals, Switzerland
| | - Béatrice Husson
- French Centre for Pediatric Stroke and Pediatric Radiology, Bicêtre University Hospital Centre, Le Kremlin-Bicêtre, France
| | - Manoelle Kossorotoff
- French Centre for Pediatric Stroke, Pediatric Neurology Department, APHP-Necker-Enfants Malades, University Hospital, Paris, France
| | - Vincent Muehlethaler
- Neonatal Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Sebastien Lebon
- Pediatric Neurology Unit, Department of Pediatrics, Lausanne University Hospital, Switzerland
| | - Stéphane Chabrier
- French Centre for Pediatric Stroke, University Hospital Centre of Saint-Etienne, 42055 Saint-Etienne Cedex 2, France
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