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Malherbe V, Celen S, Carkeek K, Carapancea E, Auriti C, Piersigilli F. Unusual cerebral intraventricular hemorrhage and cardiomyopathy related to congenital cytomegalovirus from non-primary maternal infection: a case report. Ital J Pediatr 2024; 50:71. [PMID: 38627855 PMCID: PMC11020339 DOI: 10.1186/s13052-024-01637-6] [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: 08/04/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Congenital cytomegalovirus (cCMV) infection, resulting from non-primary maternal infection or reactivation during pregnancy, can cause serious fetal abnormalities, complications in the immediate neonatal period, and severe sequelae later in childhood. Maternal non-primary cytomegalovirus infection in pregnancy is transmitted to the fetus in 0.5-2% of cases (1). CASE PRESENTATION An African full term male newbornwas delivered by emergency caesarean section. Due to signs of asphyxia at birth and clinical moderate encephalopathy, he underwent therapeutic hypothermia. Continuous full video-electroencephalography monitoring showed no seizures during the first 72 h, however, soon after rewarming, he presented refractory status epilepticus due to an intracranial hemorrhage, related to severe thrombocytopenia. The patient also presented signs of sepsis (hypotension and signs of reduced perfusions). An echocardiography revealed severe cardiac failure with an ejection fraction of 33% and signs suggestive of cardiomyopathy. Research for CMV DNA Polymerase Chain Reaction (PCR) on urine, blood, cerebrospinal fluid, and nasopharyngeal secretions was positive.The mother had positive CMV IgG with negative IgM shortly before pregnancy. Serology for CMV was therefore not repeated during pregnancy, but CMV DNA performed on the Guthrie bloodspot taken at birth yielded a positive result, confirming the intrauterine transmission and congenital origin of the infection. The baby was discharged in good general condition and follow up showed a normal neurodevelopmental outcome at 9 months. CONCLUSION Although uncommon, congenital cytomegalovirus infection should be included in the differential diagnosis of intraventricular hemorrhage and cardiomyopathy. Furthermore, this case highlights the possible severity of congenital cytomegalovirus infection, even in cases of previous maternal immunity.
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Affiliation(s)
- Victoria Malherbe
- Department of Pediatrics, Cliniques Universitaires St Luc, Brussels, Belgium
| | - Stefanie Celen
- Department of Neonatology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Katherine Carkeek
- Department of Neonatology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Evelina Carapancea
- Department of Pediatric Neurology, Cliniques Universitaires St Luc, Institute of NeuroScience, Université Catholique de Louvain, Brussels, Belgium
| | - Cinzia Auriti
- Saint Camillus International University of Health Sciences, Rome, Italy
- Department of Neonatology, Villa Margherita Private Clinic, Rome, Italy
| | - Fiammetta Piersigilli
- Department of Neonatology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium.
- Neonatal intensive care unit, Department of Neonatology, Cliniques Universitaires St Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
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Deep nuclei injury distribution in isolated “basal ganglia–thalamus” (BGT) versus combined “BGT and watershed” patterns of hypoxic–ischaemic injury (HII) in children with cerebral palsy. Clin Radiol 2022; 77:825-832. [DOI: 10.1016/j.crad.2022.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022]
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Chen X, Zhang J, Wu Y, Tucker R, Baird GL, Domonoske R, Barrios-Anderson A, Lim YP, Bath K, Walsh EG, Stonestreet BS. Inter-alpha Inhibitor Proteins Ameliorate Brain Injury and Improve Behavioral Outcomes in a Sex-Dependent Manner After Exposure to Neonatal Hypoxia Ischemia in Newborn and Young Adult Rats. Neurotherapeutics 2022; 19:528-549. [PMID: 35290609 PMCID: PMC9226254 DOI: 10.1007/s13311-022-01217-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 12/16/2022] Open
Abstract
Hypoxic-ischemic (HI) brain injury is a major contributor to neurodevelopmental morbidities. Inter-alpha inhibitor proteins (IAIPs) have neuroprotective effects on HI-related brain injury in neonatal rats. However, the effects of treatment with IAIPs on sequential behavioral, MRI, and histopathological abnormalities in the young adult brain after treatment with IAIPs in neonates remain to be determined. The objective of this study was to examine the neuroprotective effects of IAIPs at different neurodevelopmental stages from newborn to young adults after exposure of neonates to HI injury. IAIPs were given as 11-sequential 30-mg/kg doses to postnatal (P) day 7-21 rats after right common carotid artery ligation and exposure to 90 min of 8% oxygen. The resulting brain edema and injury were examined by T2-weighted magnetic resonance imaging (MRI) and cresyl violet staining, respectively. The mean T2 values of the ipsilateral hemisphere from MRI slices 6 to 10 were reduced in IAIP-treated HI males + females on P8, P9, and P10 and females on P8, P9, P10, and P14. IAIP treatment reduced hemispheric volume atrophy by 44.5 ± 29.7% in adult male + female P42 rats and improved general locomotor abilities measured by the righting reflex over time at P7.5, P8, and P9 in males + females and males and muscle strength/endurance measured by wire hang on P16 in males + females and females. IAIPs provided beneficial effects during the learning phase of the Morris water maze with females exhibiting beneficial effects. IAIPs confer neuroprotection from HI-related brain injury in neonates and even in adult rats and beneficial MRI and behavioral benefits in a sex-dependent manner.
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Affiliation(s)
- Xiaodi Chen
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA
| | - Jiyong Zhang
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA
| | - Yuqi Wu
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA
| | - Richard Tucker
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA
| | - Grayson L Baird
- Department of Diagnostic Imaging, Biostatistics Core Lifespan Hospital System, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rose Domonoske
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA
| | - Adriel Barrios-Anderson
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA
| | - Yow-Pin Lim
- ProThera Biologics, Inc, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kevin Bath
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical College, New York, NY, USA
| | - Edward G Walsh
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Barbara S Stonestreet
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA.
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Al Amrani F, Sébire G, Chen MF, Wintermark P, Saint-Martin C. Distinctive Neuroimaging Pattern in Term Newborns With Neonatal Placental Encephalopathy: A Case Series. Pediatr Neurol 2022; 126:74-79. [PMID: 34740136 DOI: 10.1016/j.pediatrneurol.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/11/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Identifying antepartum versus intrapartum timing and the cause of neonatal encephalopathy (NE) often remains elusive owing to our limited understanding of the underlying pathophysiological processes and lack of appropriate biomarkers. OBJECTIVES This retrospective observational study describes a case series of term newborns with NE who displayed a recognizable magnetic resonance imaging pattern of immediately postnatal brain abnormalities that rapidly evolved toward cavitation. Our aim is to (1) report this neuroimaging pattern, (2) look for placental determinants, and (3) depict the outcome. DESIGN/METHODS This is a unicentric retrospective case series reporting the clinical, radiological, and laboratory findings of NE associated with a distinctive neuroimaging pattern, that is, immediately postnatal extensive corticosubcortical T2 hyperintensities, followed by rapid corticosubcortical cavitation that does not match the neuroimaging picture of intrapartum hypoxic-ischemic encephalopathy (HIE). RESULTS Seven term newborns presented bilateral corticosubcortical hyperintensities that were detected on T2 between day of life (DOL) 1-4, which rapidly evolved toward cystic encephalomalacia, that is, between DOL9 and DOL12. All these newborns presented with moderate/severe NE. The outcome was either neonatal death or quadriplegic cerebral palsy and epilepsy. None of the reported patients fulfilled the criteria of a high likelihood of acute intrapartum hypoxic-ischemic or quadriplegic cerebral palsy. All these newborns were exposed to chronic and/or acute placental inflammation and/or hypoxic-ischemic. CONCLUSIONS To further define the antepartum causes of NE, early neuroimaging and a placental examination are recommended. Brain T2 hyperintense injuries before DOL4 followed by rapid cavitation before DOL12 might be biomarkers of NE from an antepartum/placental origin.
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Affiliation(s)
- Fatema Al Amrani
- Division of Pediatric Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Pediatric Neurology Unit, Child Health Department, Sultan Qaboos University Hospital, Al Khod, Muscat, Sultanate of Oman
| | - Guillaume Sébire
- Division of Pediatric Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Child Health and Human Development Program, Research Institute of McGill University Health Center, Montreal, Quebec, Canada.
| | - Moy Fong Chen
- Department of Pathology, Research Institute of McGill University Health Center, Montreal, Quebec, Canada
| | - Pia Wintermark
- Child Health and Human Development Program, Research Institute of McGill University Health Center, Montreal, Quebec, Canada; Division of Neonatology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Christine Saint-Martin
- Division of Pediatric Medical Imaging, Department of Radiology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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Varghese B, Xavier R, Manoj VC, Aneesh MK, Priya PS, Kumar A, Sreenivasan VK. Magnetic resonance imaging spectrum of perinatal hypoxic-ischemic brain injury. Indian J Radiol Imaging 2021; 26:316-327. [PMID: 27857456 PMCID: PMC5036328 DOI: 10.4103/0971-3026.190421] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Perinatal hypoxic–ischemic brain injury results in neonatal hypoxic–ischemic encephalopathy and serious long-term neurodevelopmental sequelae. Magnetic resonance imaging (MRI) of the brain is an ideal and safe imaging modality for suspected hypoxic–ischemic injury. The pattern of injury depends on brain maturity at the time of insult, severity of hypotension, and duration of insult. Time of imaging after the insult influences the imaging findings. Mild to moderate hypoperfusion results in germinal matrix hemorrhages and periventricular leukomalacia in preterm neonates and parasagittal watershed territory infarcts in full-term neonates. Severe insult preferentially damages the deep gray matter in both term and preterm infants. However, associated frequent perirolandic injury is seen in term neonates. MRI is useful in establishing the clinical diagnosis, assessing the severity of injury, and thereby prognosticating the outcome. Familiarity with imaging spectrum and insight into factors affecting the injury will enlighten the radiologist to provide an appropriate diagnosis.
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Affiliation(s)
- Binoj Varghese
- Department of Radiology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Rose Xavier
- Department of Paediatrics, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - V C Manoj
- Department of Paediatrics, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - M K Aneesh
- Department of Radiology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - P S Priya
- Department of Radiology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Ashok Kumar
- Department of Radiology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - V K Sreenivasan
- Department of Paediatrics, Amala Institute of Medical Sciences, Thrissur, Kerala, India
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6
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Pereira RG, Ribeiro BNDF, Hollanda RTDL, de Almeida LB, Simeão TB, Marchiori E. Non-neoplastic intracranial cystic lesions: not everything is an arachnoid cyst. Radiol Bras 2021; 54:49-55. [PMID: 33574631 PMCID: PMC7863714 DOI: 10.1590/0100-3984.2019.0144] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Intracranial cystic lesions are common findings on neuroimaging examinations, arachnoid cysts being the most common type of such lesions. However, various lesions of congenital, infectious, or vascular origin can present with cysts. In this pictorial essay, we illustrate the main causes of non-neoplastic intracranial cystic lesions, discussing their possible differential diagnoses as well as their most relevant imaging aspects.
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Affiliation(s)
| | - Bruno Niemeyer de Freitas Ribeiro
- Hospital Casa de Portugal / 3D Diagnóstico por Imagem, Rio de Janeiro, RJ, Brazil.,Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Maxwell JR, Zimmerman AJ, Pavlik N, Newville JC, Carlin K, Robinson S, Brigman JL, Northington FJ, Jantzie LL. Neonatal Hypoxic-Ischemic Encephalopathy Yields Permanent Deficits in Learning Acquisition: A Preclinical Touchscreen Assessment. Front Pediatr 2020; 8:289. [PMID: 32582593 PMCID: PMC7291343 DOI: 10.3389/fped.2020.00289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/07/2020] [Indexed: 12/13/2022] Open
Abstract
Neonatal hypoxic-ischemic encephalopathy (HIE) remains a common problem world-wide for infants born at term. The impact of HIE on long-term outcomes, especially into adulthood, is not well-described. To facilitate identification of biobehavioral biomarkers utilizing a translational platform, we sought to investigate the impact of HIE on executive function and cognitive outcomes into adulthood utilizing a murine model of HIE. HIE mice (unilateral common carotid artery occlusion to induce ischemia, followed by hypoxia with a FiO2 of 0.08 for 45 min) and control mice were tested on discrimination and reversal touchscreen tasks (using their noses) shown to be sensitive to loss of basal ganglia or cortical function, respectively. We hypothesized that the HIE injury would result in deficits in reversal learning, revealing complex cognitive and executive functioning impairments. Following HIE, mice had a mild discrimination impairment as measured by incorrect responses but were able to learn the paradigm to similar levels as controls. During reversal, HIE mice required significantly more total trials, errors and correction trials across the paradigm. Analysis of specific stages showed that reversal impairments in HIE were driven by significant increases in all measured parameters during the late learning, striatal-mediated portion of the task. Together, these results support the concept that HIE occurring during the neonatal period results in abnormal neurodevelopment that persists into adulthood, which can impact efficient associated learning. Further, these data show that utilization of an established model of HIE coupled with touchscreen learning provides valuable information for screening therapeutic interventions that could mitigate these deficits to improve the long-term outcomes of this vulnerable population.
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Affiliation(s)
- Jessie R. Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
| | - Amber J. Zimmerman
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
| | - Nathaniel Pavlik
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
| | - Jessie C. Newville
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
| | - Katherine Carlin
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shenandoah Robinson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jonathan L. Brigman
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
| | - Frances J. Northington
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lauren L. Jantzie
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Kennedy Krieger Institute, Baltimore, MD, United States
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8
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Koshino S, Hayakawa K, Tanda K, Morishita H, Ono K, Nishimura A, Koshino K, Yamada K. Magnetic resonance imaging features of four neonates with total brain injury. Childs Nerv Syst 2020; 36:1223-1229. [PMID: 31865401 DOI: 10.1007/s00381-019-04457-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/28/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE The most severe form of profound asphyxia in neonates is now known as "total brain injury," which forms part of the clinical spectrum of hypoxic-ischemic encephalopathy (HIE). Although the magnetic resonance (MR) imaging features of total brain injury remain to be determined, a widespread hyperintensity of the supratentorial brain, known as the "white cerebrum sign," has been reported in diffusion-weighted images (DWI). METHODS We examined four neonates who developed severe profound asphyxia. RESULTS In the first week of life, all neonates showed the white cerebrum sign on DWI. A follow-up of these cases over a period of 1 month revealed diffuse bilateral multicystic encephalomalacia (MCE) as well as shrinkage of the basal ganglia and thalami (BG/T). These MR findings were common to all neonates, and all the neonates had severe adverse clinical outcomes. CONCLUSION Neonates, who exhibit the white cerebrum sign on MR imaging due to profound asphyxia, develop major disabilities, and MCE with shrinkage of the BG/T suggests miserable outcomes.
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Affiliation(s)
- Sachiko Koshino
- Radiology, Japanese Red Cross Kyoto Daiichi Hospital, Honnmachi higashiyama-ku, Kyoto City, 605-0981, Japan.
- Radiology, Kyoto Kuramaguchi Medical Center, 27 koyama shimohusa-cho, Kyoto City, Kita-ku, 603-8151, Japan.
| | - Katsumi Hayakawa
- Radiology, Japanese Red Cross Kyoto Daiichi Hospital, Honnmachi higashiyama-ku, Kyoto City, 605-0981, Japan
| | - Koichi Tanda
- Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, 749 Honmachi higashiyama-ku, Kyoto City, 605-0981, Japan
| | - Hiroyuki Morishita
- Radiology, Japanese Red Cross Kyoto Daiichi Hospital, Honnmachi higashiyama-ku, Kyoto City, 605-0981, Japan
| | - Kohji Ono
- Radiology, Japanese Red Cross Kyoto Daiichi Hospital, Honnmachi higashiyama-ku, Kyoto City, 605-0981, Japan
| | - Akira Nishimura
- Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, 749 Honmachi higashiyama-ku, Kyoto City, 605-0981, Japan
| | - Katsuhiro Koshino
- Surgery, North Medical Center, Kyoto Prefectural University of Medicine, 481 otokoyama yosano-cho yosa-gunn, Kyoto City, 629-2261, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, kawaramachi-tori 465 kajii-cho hirokoji agaru kamigyo-ku, Kyoto City, 602-0841, Japan
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9
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Magnetic resonance imaging findings in patients with cerebral palsy in Duhok, Iraq: Case series. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.663221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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The influence of anesthetics on substantia nigra tyrosine hydroxylase expression and tau phosphorylation in the hypoxic-ischemic near-term lamb. Pediatr Res 2018; 83:1190-1199. [PMID: 29741516 DOI: 10.1038/pr.2018.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/22/2018] [Indexed: 11/08/2022]
Abstract
BackgroundGeneral anesthetics could protect key neurotransmitter systems, such as the dopaminergic system, from hypoxic-ischemic encephalopathy (HIE) by limiting excessive glutamatergic neurotransmission. However, anesthetics may adversely affect inflammation and tau phosphorylation.MethodsA near-term sheep model of HIE by umbilical cord occlusion (UCO) under anesthesia was used. The effect of propofol and isoflurane on the dopaminergic neurotransmitter phenotype in the substantia nigra (SN) was studied using tyrosine hydroxylase immunohistochemistry. The overall microglial response and tau phosphorylation were also measured in the SN, surrounding the midbrain gray matter structures and the hippocampal white matter.ResultsThe isoflurane-treated UCO group had fewer tyrosine hydroxylase-expressing neurons in the SN at 8 h after the insult than the propofol-treated UCO or sham-operated groups (P<0.05). The microglial response was unchanged in the SN region. In the thalamus and the hippocampal stratum moleculare layer, the propofol-treated UCO group had a lower microglial response than the corresponding sham-operated group. Both UCO and the use of anesthetics additively increased tau phosphorylation in the SN region, thalamus, and hippocampus.ConclusionThe choice of anesthetics is important for an emergency C-section. Propofol could potentially protect the dopaminergic neurotransmitter phenotype within the SN at the cost of a widespread increase in tau phosphorylation.
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11
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Driscoll DJO', Felice VD, Kenny LC, Boylan GB, O'Keeffe GW. Mild prenatal hypoxia-ischemia leads to social deficits and central and peripheral inflammation in exposed offspring. Brain Behav Immun 2018; 69:418-427. [PMID: 29355822 DOI: 10.1016/j.bbi.2018.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/14/2017] [Accepted: 01/11/2018] [Indexed: 12/16/2022] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) resulting from intrauterine or perinatal hypoxic-ischemia (HI) is a leading cause of long-term neonatal neurodisability. While most studies of long-term outcome have focused on moderate and severe HIE in term infants, recent work has shown that those with mild HIE may have subtle neurological impairments. However, the impact of mild HI on pre-term infants is much less clear given that pre-term birth is itself a risk factor for neurodisability. Here we show that mild HI insult alters behaviour, inflammation and the corticosterone stress response in a rat model of pre-term HIE. Mild HI exposure led to social deficits in exposed offspring at postnatal day 30, without impairments in the novel object recognition test nor in the open field test. This was also accompanied by elevations in circulating adrenocorticotropic hormone and corticosterone indicating an exaggerated stress response. There were also elevations in il-1β and il-6 but not tnf-α mRNA and protein in the brain and blood samples. In summary we find that a mild HI exposure leads to social deficits, central and peripheral inflammation, and an abnormal corticosterone response which are three core features of autism spectrum disorder. This shows that mild HI exposure may be a risk factor for an abnormal neurodevelopmental outcome in pre-term offspring.
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Affiliation(s)
- David J O ' Driscoll
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, Cork, Ireland; Department of Obstetrics & Gynaecology, University College Cork (UCC), Cork, Ireland
| | - Valeria D Felice
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, Cork, Ireland; Department of Pharmacology, School of Pharmacy, UCC, Cork, Ireland
| | - Louise C Kenny
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, Cork, Ireland; Department of Obstetrics & Gynaecology, University College Cork (UCC), Cork, Ireland
| | - Geraldine B Boylan
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, Cork, Ireland; Department of Paediatrics and Child Health, UCC, Cork, Ireland
| | - Gerard W O'Keeffe
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, Cork, Ireland; Department of Anatomy and Neuroscience and Cork Neuroscience Centre, UCC, Cork, Ireland.
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12
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Barkhuizen M, van den Hove DLA, Vles JSH, Steinbusch HWM, Kramer BW, Gavilanes AWD. 25 years of research on global asphyxia in the immature rat brain. Neurosci Biobehav Rev 2017; 75:166-182. [PMID: 28161509 DOI: 10.1016/j.neubiorev.2017.01.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/27/2017] [Accepted: 01/29/2017] [Indexed: 10/20/2022]
Abstract
Hypoxic-ischemic encephalopathy remains a common cause of brain damage in neonates. Preterm infants have additional complications, as prematurity by itself increases the risk of encephalopathy. Currently, therapy for this subset of asphyxiated infants is limited to supportive care. There is an urgent need for therapies in preterm infants - and for representative animal models for preclinical drug development. In 1991, a novel rodent model of global asphyxia in the preterm infant was developed in Sweden. This method was based on the induction of asphyxia during the birth processes itself by submerging pups, still in the uterine horns, in a water bath followed by C-section. This insult occurs at a time-point when the rodent brain maturity resembles the brain of a 22-32 week old human fetus. This model has developed over the past 25 years as an established model of perinatal global asphyxia in the early preterm brain. Here we summarize the knowledge gained on the short- and long-term neuropathological and behavioral effects of asphyxia on the immature central nervous system.
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Affiliation(s)
- M Barkhuizen
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; DST/NWU Preclinical Drug Development Platform, North-West University, Potchefstroom, South Africa
| | - D L A van den Hove
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - J S H Vles
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Child Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - H W M Steinbusch
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - B W Kramer
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - A W D Gavilanes
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Institute of Biomedicine, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Ecuador.
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Barkhuizen M, Van de Berg WDJ, De Vente J, Blanco CE, Gavilanes AWD, Steinbusch HWM. Nitric Oxide Production in the Striatum and Cerebellum of a Rat Model of Preterm Global Perinatal Asphyxia. Neurotox Res 2017; 31:400-409. [PMID: 28110393 PMCID: PMC5360831 DOI: 10.1007/s12640-017-9700-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/30/2016] [Accepted: 01/02/2017] [Indexed: 11/29/2022]
Abstract
Encephalopathy due to perinatal asphyxia (PA) is a major cause of neonatal morbidity and mortality in the period around birth. Preterm infants are especially at risk for cognitive, attention and motor impairments. Therapy for this subgroup is limited to supportive care, and new targets are thus urgently needed. Post-asphyxic excitotoxicity is partially mediated by excessive nitric oxide (NO) release. The aims of this study were to determine the timing and distribution of nitric oxide (NO) production after global PA in brain areas involved in motor regulation and coordination. This study focused on the rat striatum and cerebellum, as these areas also affect cognition or attention, in addition to their central role in motor control. NO/peroxynitrite levels were determined empirically with a fluorescent marker on postnatal days P5, P8 and P12. The distributions of neuronal NO synthase (nNOS), cyclic guanosine monophosphate (cGMP), astroglia and caspase-3 were determined with immunohistochemistry. Apoptosis was additionally assessed by measuring caspase-3-like activity from P2-P15. On P5 and P8, increased intensity of NO-associated fluorescence and cGMP immunoreactivity after PA was apparent in the striatum, but not in the cerebellum. No changes in nNOS immunoreactivity or astrocytes were observed. Modest changes in caspase-3-activity were observed between groups, but the overall time course of apoptosis over the first 11 days of life was similar between PA and controls. Altogether, these data suggest that PA increases NO/peroxynitrite levels during the first week after birth within the striatum, but not within the cerebellum, without marked astrogliosis. Therapeutic benefits of interventions that reduce endogenous NO production would likely be greater during this time frame.
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Affiliation(s)
- M Barkhuizen
- Department Pediatrics, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.,Department Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.,EURON - European Graduate School of Neuroscience, Maastricht, The Netherlands.,DST/NWU Preclinical Drug Development Platform, North-West University, Potchefstroom, South Africa
| | - W D J Van de Berg
- Department Pediatrics, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.,Department Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.,Department of Anatomy and Neurosciences, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, Netherlands
| | - J De Vente
- Department Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - C E Blanco
- Department Pediatrics, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - A W D Gavilanes
- Department Pediatrics, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.,EURON - European Graduate School of Neuroscience, Maastricht, The Netherlands.,Institute of Biomedicine, Faculty of Medicine, Catholic University of Guayaquil, Guayaquil, Ecuador
| | - H W M Steinbusch
- Department Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands. .,EURON - European Graduate School of Neuroscience, Maastricht, The Netherlands. .,Department of Translational Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 5800, 6212 AZ, Maastricht, The Netherlands.
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Dinan D, Daneman A, Guimaraes CV, Chauvin NA, Victoria T, Epelman M. Easily Overlooked Sonographic Findings in the Evaluation of Neonatal Encephalopathy: Lessons Learned From Magnetic Resonance Imaging. Semin Ultrasound CT MR 2014; 35:627-51. [DOI: 10.1053/j.sult.2014.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Bekiesińska-Figatowska M, Szkudlińska-Pawlak S, Romaniuk-Doroszewska A, Duczkowski M, Iwanowska B, Duczkowska A, Mądzik J, Brągoszewska H. First Experience with Neonatal Examinations with the Use of MR-Compatible Incubator. Pol J Radiol 2014; 79:268-74. [PMID: 25152798 PMCID: PMC4140722 DOI: 10.12659/pjr.890371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 01/31/2014] [Indexed: 11/13/2022] Open
Abstract
Background Since 2003, very few publications have described brain examinations using neonatal MR-compatible incubator (INC). The authors present their first experience in these examinations, not limited to brain scans, with the use of an incubator equipped not only with head coil, but also with a coil designed for examinations of the spinal canal and spinal cord as well as the whole body, at the Institute of Mother and Child in Warsaw. Material/Methods Examinations were performed in 27 newborns (12 girls, 15 boys). Most of the neonates were prematurely born: 19 (70.4%) were born at gestational age of 23–37 weeks, mean of 30 weeks. They were examined at the corrected age of 26 weeks–1 month, mean of 36 weeks. Body weight of the newborns on the day of the study was 600–4,300 g, mean of 2,654 g. The study was performed with a GE Signa HDxT 1.5 T system with the use of a Nomag IC 1.5 incubator by Lammers Medical Technology Co., equipped with three coils: an eight-channel, phased-array head coil and a twelve-channel phased-array coil for the whole body, consisting of an eight-channel coil integrated in the incubator and a separate four-channel surface coil. Results Of the 27 children, 25 (92.6%) required a brain scan. Two children (7.4%) were referred to MRI for assessment of the spinal canal and the abdomen. We compared the results of transfontanelle ultrasound and MRI scans in 21 children. MRI provided significantly more diagnostic information in 18 cases (85.7%); in 3 cases (14.3%), no additional knowledge about the pathology was provided by the exam. Conclusions The MR-compatible incubator increases the availability of MRI to newborns, especially premature newborns and those with low and extremely low body weight, for whom MR examinations are necessary to determine the extent of changes, not limited to the central nervous system, as well as to establish prognosis. Dedicated neonatal coils integrated with the incubator permit more accurate diagnosis than the previously used adult coils.
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Affiliation(s)
| | | | | | - Marek Duczkowski
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
| | - Beata Iwanowska
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
| | | | - Jarosław Mądzik
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
| | - Hanna Brągoszewska
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
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Helwich E, Bekiesińska-Figatowska M, Bokiniec R. Recommendations regarding imaging of the central nervous system in fetuses and neonates. J Ultrason 2014; 14:203-16. [PMID: 26672743 PMCID: PMC4579694 DOI: 10.15557/jou.2014.0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 11/07/2013] [Accepted: 11/13/2013] [Indexed: 11/22/2022] Open
Abstract
An abnormal presentation of the central nervous system in a fetus during a screening examination is an indication for extended diagnosis, the aim of which is to explain the character of such an anomaly (a congenital defect, destructive effect of intrauterine infection or abnormality with reasons that are difficult to explain). Knowledge of normal development sequence of the fetal brain, which is discussed in this paper, is the basis for correct interpretation of imaging findings. Together with the increase in survival of preterm neonates, a high risk of early brain damage is still a problem in this extremely immature population. Therefore, imaging examinations become necessary. The paper presents intrauterine and postnatal risk factors of early brain damage as well as classification of such lesions, of hemorrhagic and hypoxic-ischemic etiology. The diagnosis of the cerebellum damage, which is currently believed to be a significant cause of autism, is emphasized. The evolution of lesions over time is also presented. Moreover, the elements of diagnosis important for prognosis are stressed. The standards of imaging examinations of the central nervous system include the schedule of ultrasound examinations and provide indications for extended diagnosis with the use of magnetic resonance imaging.
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Affiliation(s)
- Ewa Helwich
- Klinika Neonatologii i Intensywnej Terapii Noworodka, Instytut Matki i Dziecka, Warszawa, Polska
| | | | - Renata Bokiniec
- Klinika Neonatologii i Intensywnej Terapii Noworodka, Warszawski Uniwersytet Medyczny, Warszawa, Polska
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