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Venous subtypes of preterm periventricular haemorrhagic infarction

Abstract

Background: Periventricular haemorrhagic infarction (PVHI) is a complication of preterm birth that may lead to impairment and disability. Early diagnosis is possible by cranial ultrasonography (CUS). Extensive PVHI lesions can be graded using a scoring system that relates to outcome, based on CUS characteristics. Data on more subtle unilateral forms of PVHI are lacking.

Objective: To refine the PVHI classification by relating subtypes to affected veins and to evaluate the effects of these anatomical subtypes on neurological outcome.

Methods: Retrospective analysis of images and neurological outcome of 20 preterm infants with unilateral PVHI. Based on affected veins, PVHI was classified into six subtypes. Sonographic templates of infarct types are provided in the coronal and parasagittal planes. Standardised neurological examinations were done (according to Amiel–Tison and Touwen examinations) and children were classified as: normal, mildly or definitely abnormal. The outcome was based on the most recent neurological examination, at a corrected age of 1 (n = 7), 2 (n = 5), 3 (n = 5) or 5 (n = 3) years.

Results: PVHI classification of the 20 patients was as follows: temporal (n = 3), pure caudate (n = 3), anterior terminal (n = 6), complete terminal (n = 3), extensive (n = 4), other (n = 1). With one exception, only PVHI patients showing the latter three subtypes had developed severe spastic contralesional hemiplegia.

Conclusions: The classification was developed for PVHI correlates with neurological outcome. This refined classification can help clinicians in predicting neurological outcome at an early stage, with a subsequent targeted rehabilitation schedule instituted early in life.

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