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Lu D, Tan J, Xu H. Ventriculoperitoneal shunt for giant porencephaly: a case report and literature review. Front Surg 2024; 11:1389050. [PMID: 38708364 PMCID: PMC11066292 DOI: 10.3389/fsurg.2024.1389050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Abstract
Porencephaly (POR) is an exceedingly rare neurological disorder characterized by the presence of solitary or multiple regressive cerebrospinal fluid (CSF) cavities within the brain parenchyma. Currently, there is a limited understanding of the pathogenesis and treatment options for this condition, and clinical presentations can vary significantly. However, imaging plays a crucial role in diagnosis and determining the optimal treatment strategy, necessitating individualized comprehensive treatment upon detection. We reported a 25-year-old male case with persistent head pain that did not resolve with rest. Magnetic resonance imaging (MRI) confirmed the giant POR, and we finally performed a ventriculoperitoneal shunt, and the symptoms of intracranial hypertension were relieved after surgery.
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Affiliation(s)
| | | | - Haitong Xu
- Department of Neurosurgery, Guangdong Sanjiu Brain Hospital, Guangzhou, China
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Adam AP, Payton KSE, Sanchez-Lara PA, Adam MP, Mirzaa GM. Hypoxia: A teratogen underlying a range of congenital disruptions, dysplasias, and malformations. Am J Med Genet A 2021; 185:2801-2808. [PMID: 33938618 DOI: 10.1002/ajmg.a.62235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/12/2021] [Accepted: 04/15/2021] [Indexed: 01/20/2023]
Abstract
In this review, we explore evidence that hypoxia in the developing human fetus can lead not only to the more commonly accepted disruptive-type defects, but also patterns of anomalies that suggest that hypoxia can exert a more classic teratogenic effect, using the brain as one example. We review neuropathology in the context of intrauterine hypoxia, particularly as it relates to carbon monoxide poisoning, in utero strokes, and homozygous alpha-thalassemia. In general, the associated brain injuries resemble those seen with other causes of hypoxic-ischemic injury. Fetal strokes during development usually lead to loss of brain tissue in areas that do not follow a typical embryologic pattern, and therefore are considered disruptions. However, there is also evidence that fetal brain ischemia can cause more classically recognized patterns of abnormal embryonic neuronal migration and organization such as polymicrogyria, cortical dysplasia, or dysgenesis, including select types of focal cortical dysplasia. This study summarizes available literature and evidence to raise clinicians' awareness regarding the association between hypoxia and congenital anomalies, including brain malformations.
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Affiliation(s)
- Aaron P Adam
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kurlen S E Payton
- Division of Neonatology, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Pedro A Sanchez-Lara
- Division of Neonatology, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Medical Genetics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Margaret P Adam
- Divison of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Ghayda M Mirzaa
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Divison of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Kirkham FJ, Zafeiriou D, Howe D, Czarpran P, Harris A, Gunny R, Vollmer B. Fetal stroke and cerebrovascular disease: Advances in understanding from lenticulostriate and venous imaging, alloimmune thrombocytopaenia and monochorionic twins. Eur J Paediatr Neurol 2018; 22:989-1005. [PMID: 30467085 DOI: 10.1016/j.ejpn.2018.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022]
Abstract
Fetal stroke is an important cause of cerebral palsy but is difficult to diagnose unless imaging is undertaken in pregnancies at risk because of known maternal or fetal disorders. Fetal ultrasound or magnetic resonance imaging may show haemorrhage or ischaemic lesions including multicystic encephalomalacia and focal porencephaly. Serial imaging has shown the development of malformations including schizencephaly and polymicrogyra after ischaemic and haemorrhagic stroke. Recognised causes of haemorrhagic fetal stroke include alloimmune and autoimmune thrombocytopaenia, maternal and fetal clotting disorders and trauma but these are relatively rare. It is likely that a significant proportion of periventricular and intraventricular haemorrhages are of venous origin. Recent evidence highlights the importance of arterial endothelial dysfunction, rather than thrombocytopaenia, in the intraparenchymal haemorrhage of alloimmune thrombocytopaenia. In the context of placental anastomoses, monochorionic diamniotic twins are at risk of twin twin transfusion syndrome (TTTS), or partial forms including Twin Oligohydramnios Polyhydramnios Sequence (TOPS), differences in estimated weight (selective Intrauterine growth Retardation; sIUGR), or in fetal haemoglobin (Twin Anaemia Polycythaemia Sequence; TAPS). There is a very wide range of ischaemic and haemorrhagic injury in a focal as well as a global distribution. Acute twin twin transfusion may account for intraventricular haemorrhage in recipients and periventricular leukomalacia in donors but there are additional risk factors for focal embolism and cerebrovascular disease. The recipient has circulatory overload, with effects on systemic and pulmonary circulations which probably lead to systemic and pulmonary hypertension and even right ventricular outflow tract obstruction as well as the polycythaemia which is a risk factor for thrombosis and vasculopathy. The donor is hypovolaemic and has a reticulocytosis in response to the anaemia while maternal hypertension and diabetes may influence stroke risk. Understanding of the mechanisms, including the role of vasculopathy, in well studied conditions such as alloimmune thrombocytopaenia and monochorionic diamniotic twinning may lead to reduction of the burden of antenatally sustained cerebral palsy.
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Affiliation(s)
- Fenella J Kirkham
- Developmental Neurosciences Section and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom; Clinical and Experimental Sciences, University of Southampton, United Kingdom.
| | - Dimitrios Zafeiriou
- 1st Department of Pediatrics, "Hippokratio' General Hospital, Aristotle University, Thessaloniki, Greece
| | - David Howe
- Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom; Clinical and Experimental Sciences, University of Southampton, United Kingdom
| | - Philippa Czarpran
- Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom
| | - Ashley Harris
- Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom
| | - Roxanna Gunny
- Developmental Neurosciences Section and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Radiology, St George's hospital, London, United Kingdom
| | - Brigitte Vollmer
- Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom; Clinical and Experimental Sciences, University of Southampton, United Kingdom
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Bothuyne-Queste E, Joriot S, Mathieu D, Mathieu-Nolf M, Favory R, Houfflin-Debarge V, Vaast P, Closset E, Subtil D. [Ten practical issues concerning acute poisoning with carbon monoxide in pregnant women]. ACTA ACUST UNITED AC 2013; 43:281-7. [PMID: 23562321 DOI: 10.1016/j.jgyn.2013.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/20/2013] [Accepted: 03/04/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND The poisoning of carbon monoxide (CO) is the leading cause of death by poisoning in France. Its consequences are potentially serious to the fetus. Literature is ancient and little known. PURPOSE AND METHOD Make an inventory of knowledge about carbon monoxide poisoning during pregnancy. RESULT The CO causes maternal then fetal tissue hypoxia primarily by binding to hemoglobin with which it has a high affinity. Its transplacental passage may cause fetal harm, predominantly in the brain. Severity seems correlated with maternal symptoms during exposure. In the absence of maternal symptoms, however, the available data are reassuring. Hyperbaric oxygen therapy may reduce the risk to the fetus. DISCUSSION Oxygen therapy should be offered in all cases of CO poisoning, especially if there are maternal symptoms during exposure. In addition, a fetal echography directed on the cephalic pole - even a fetal magnetic resonance imaging three weeks after exposure - should also be proposed.
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Affiliation(s)
- E Bothuyne-Queste
- Université Lille Nord de France, hôpital Jeanne de Flandre, pôle Femme-Mère-Nouveau-né, 2, avenue Oscar-Lambret, 59000 Lille cedex, France.
| | - S Joriot
- Université Lille Nord de France, hôpital Jeanne de Flandre, pôle Femme-Mère-Nouveau-né, 2, avenue Oscar-Lambret, 59000 Lille cedex, France
| | - D Mathieu
- Centre d'oxygénothérapie hyperbare, université Lille Nord de France, hôpital Calmette, 59000 Lille, France
| | - M Mathieu-Nolf
- Centre anti-poisons, université Lille Nord de France, CHRU de Lille, 59000 Lille, France
| | - R Favory
- Centre d'oxygénothérapie hyperbare, université Lille Nord de France, hôpital Calmette, 59000 Lille, France
| | - V Houfflin-Debarge
- Université Lille Nord de France, hôpital Jeanne de Flandre, pôle Femme-Mère-Nouveau-né, 2, avenue Oscar-Lambret, 59000 Lille cedex, France
| | - P Vaast
- Université Lille Nord de France, hôpital Jeanne de Flandre, pôle Femme-Mère-Nouveau-né, 2, avenue Oscar-Lambret, 59000 Lille cedex, France
| | - E Closset
- Université Lille Nord de France, hôpital Jeanne de Flandre, pôle Femme-Mère-Nouveau-né, 2, avenue Oscar-Lambret, 59000 Lille cedex, France
| | - D Subtil
- Université Lille Nord de France, hôpital Jeanne de Flandre, pôle Femme-Mère-Nouveau-né, 2, avenue Oscar-Lambret, 59000 Lille cedex, France; EA 2694, université Lille Nord de France, 59000 Lille, France
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Tsunematsu R, Shinozaki T, Fukushima K, Yumoto Y, Hidaka N, Morokuma S, Fujita Y, Hojo S, Wake N. Congenital Abdominal Aortic Aneurysm with Porencephaly: A Case Report. Fetal Diagn Ther 2011; 29:248-52. [DOI: 10.1159/000322403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 10/25/2010] [Indexed: 11/19/2022]
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