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Horsch S, Schwarz S, Arnaez J, Steggerda S, Arena R, Govaert P. Cerebral Doppler imaging in neonates: A guide for clinical application and diagnosis. Dev Med Child Neurol 2024. [PMID: 38940604 DOI: 10.1111/dmcn.15998] [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: 08/15/2023] [Revised: 04/30/2024] [Accepted: 05/22/2024] [Indexed: 06/29/2024]
Abstract
Cranial ultrasound reliably diagnoses many neonatal brain disorders. Adding Doppler imaging expands the spectrum by providing information on the status of the vasculature and haemodynamics that may guide further diagnostic and clinical management. Doppler imaging may identify neonates with congenital or acquired vascular abnormalities such as perinatal stroke, sinuvenous thrombosis, vein of Galen malformation, dural sinus malformation, sinus pericranii, and developmental venous anomaly. These entities may need further investigation with complementary imaging modalities such as magnetic resonance imaging and magnetic resonance angiography, or conventional angiography. This review aims to help clinicians to improve their Doppler sonography knowledge and skills in order to use this helpful tool in neonates with neurological symptoms or suspected cerebral vascular abnormalities admitted to the neonatal intensive care unit.
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Affiliation(s)
- Sandra Horsch
- Department of Neonatology, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Simone Schwarz
- Department of Neonatology and Pediatric Intensive Care Medicine, Sana Clinics, Duisburg, Germany
| | - Juan Arnaez
- Hospital Universitario de Burgos, Burgos, Spain
- Neonatal Neurology, NeNe Foundation, Madrid, Spain
| | - Sylke Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Roberta Arena
- Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy
| | - Paul Govaert
- Department of Neonatology, UZBrussel, Brussels, Belgium
- Department of Neonatology, ZNA Middelheim, Antwerp, Belgium
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Ashwal E, Blaser S, Leckie A, Kajal D, Krishnan P, Chong K, Roifman M, Toi A, Chitayat D. Anterior extension of the choroid plexus into the frontal horns of the fetal lateral cerebral ventricles: Prenatal findings and postnatal outcome. Prenat Diagn 2023; 43:756-762. [PMID: 36946677 DOI: 10.1002/pd.6344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To evaluate the short- and long-term outcome of fetuses with evidence of extension of the choroid plexus into the frontal horns. METHODS This is a retrospective cohort study of fetuses diagnosed with isolated choroid plexi extending into the frontal horns. Fetuses with major central nervous system anomalies were excluded. Ultrasound and fetal/postnatal magnetic resonance imaging (MRI) were evaluated. Postnatal outcomes, including developmental assessment, were obtained. RESULTS Twenty nine fetuses were diagnosed with choroid plexus extension (22 unilateral and 7 bilateral). Gestational age at diagnosis was 19.3 weeks. Three cases (10.3%) presented with nonspecific extra-CNS findings. At presentation, 8/29 (28%) cases had single/multiple choroid plexus cysts (CPC). Twenty-six (89.6%) cases underwent antenatal MRI. On MRI, four cases had punctate susceptibility weighted imaging (SWI) foci suggesting trace hemosiderin and two cases had ventriculomegaly. Antenatal follow-up demonstrated resolution of the choroid plexus extension in 90% (18/20). Gestational age at delivery was 39.6 weeks. All had normal neurologic examinations within 24 h of life. Postnatal MRI studies were notable for deep venous differences in seven cases. Long-term clinical outcome was assessed in 14 cases with a median follow-up of 1.75 years, with normal neurodevelopment reported in 13/14 (92.8%). CONCLUSIONS Most fetuses with an anterior extension of the choroid plexus as the sole sonographic finding had favorable outcomes.
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Affiliation(s)
- Eran Ashwal
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Susan Blaser
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Division of Neuroradiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Leckie
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Dilkash Kajal
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Division of Neuroradiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karen Chong
- Department of Obstetrics and Gynecology, The Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Maian Roifman
- Department of Obstetrics and Gynecology, The Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ants Toi
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - David Chitayat
- Department of Obstetrics and Gynecology, The Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Campi F, De Rose DU, Pugnaloni F, Ronci S, Calì M, Pro S, Longo D, Lucignani G, Raho L, Pisaneschi E, Digilio MC, Savarese I, Bersani I, Amante PG, Conti M, De Liso P, Capolupo I, Braguglia A, Gandolfo C, Dotta A. Neurodevelopmental and genetic findings in neonates with intracranial arteriovenous shunts: A case series. Front Pediatr 2023; 11:1111527. [PMID: 37063679 PMCID: PMC10090511 DOI: 10.3389/fped.2023.1111527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/15/2023] [Indexed: 04/18/2023] Open
Abstract
Background Despite the latest advances in prenatal diagnosis and postnatal embolization procedures, intracranial arteriovenous shunts (AVSs) are still associated with high mortality and morbidity rates. Our aim was to evaluate the presentation and clinical course, the neurodevelopmental outcome, and the genetic findings of neonates with AVSs. Methods In this retrospective observational study, medical records of neonates with cerebral AVSs admitted to our hospital from January 2020 to July 2022 were revised. In particular, we evaluated neuroimaging characteristics, endovascular treatment, neurophysiological features, neurodevelopmental outcomes, and genetic findings. Results We described the characteristics of 11 patients with AVSs. Ten infants (90.9%) required embolization during the first three months of life. In 5/9 infants, pathological electroencephalography findings were observed; of them, two patients presented seizures. Eight patients performed Median Nerve Somatosensory Evoked Potentials (MN-SEPs): of them, six had an impaired response. We found normal responses at Visual Evoked Potentials and Brainstem Auditory Evoked Potentials. Eight patients survived (72.7%) and were enrolled in our multidisciplinary follow-up program. Of them, 7/8 completed the Bayley-III Scales at 6 months of corrected age: none of them had cognitive and language delays; conversely, a patient had a moderate delay on the Motor scale. The remaining survivor patient developed cerebral palsy and could not undergo Bayley-III evaluation because of the severe psychomotor delay. From the genetic point of view, we found a novel pathogenic variant in the NOTCH3 gene and three additional genomic defects of uncertain pathogenicity. Conclusion We propose SEPs as an ancillary test to discern the most vulnerable infants at the bedside, particularly to identify possible future motor impairment in follow-up. The early identification of a cognitive or motor delay is critical to intervene with personalized rehabilitation treatment and minimize future impairment promptly. Furthermore, the correct interpretation of identified genetic variants could provide useful information, but further studies are needed to investigate the role of these variants in the pathogenesis of AVSs.
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Affiliation(s)
- Francesca Campi
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
- Correspondence: Francesca Campi
| | | | - Flaminia Pugnaloni
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Sara Ronci
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Monica Calì
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Stefano Pro
- Development Neurology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Daniela Longo
- Neuroradiology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Giulia Lucignani
- Neuroradiology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Laura Raho
- Clinical Psychology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Elisa Pisaneschi
- Translational Cytogenomics Research Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Immacolata Savarese
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Iliana Bersani
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | | | - Marta Conti
- Clinical and Experimental Neurology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Paola De Liso
- Clinical and Experimental Neurology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Irma Capolupo
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Annabella Braguglia
- Neonatal Sub-Intensive Care Unit and Follow-up, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Carlo Gandolfo
- Neuroradiology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
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