Neuroimaging and functional outcome of neonatal leukomalacia

doi:10.1016/S0166-4328(05)80190-1

Behavioural Brain Research

Volume 49, Issue 1, 31 July 1992, Pages 7-19

https://doi.org/10.1016/S0166-4328(05)80190-1 Get rights and content

Leukomalacia is a major cause of neurological impairment in the high-risk newborn. It can be identified during the early postnatal periodby means of ultrasound (US) imaging of the brain, through the anterior fontanel. Magnetic resonance imaging (MRI) permits an optimal differentiation of brain tissue and of its abnormalities, without resorting to ionizing radiation or intravenous contrast. It is particularly appropriate for following the evolution of leukomalacia, after fontanel closure. Ninety-five fullterm and preterm infants with cystic and non-cystic leukomalacia, documented by US, were clinically followed-up until at least 12 months of corrected age. Thirty-two had a severe neurological outcome (mainly cerebral palsy, sometimes associated with mental retardation and/or cerebral visual impairment). The prognosis was worse in cystic leukomalacia than in prolonged flare. Electroencephalogram (EEG) carried out in the first 2 weeks of life provided valuable indexes of further outcome, especially for US findings of more uncertain prognosis. MRI was carried out at around 12 months of corrected age, by means of an apparatus operating at 0.5 Tesla. The main categories of abnormalities observed were the following: cystic lesions, enlarged ventricles with irregular outlines, delayed myelination, high intensity areas in the long TR (repetition time) images within the white matter, cortical atrophy. MRI findings correlated well with the results of US imaging and often with motor, cognitive and visual impairments. Nevertheless, clinical features cannot be predicted by neuroimaging alone and a comprehensive approach, including longitudinal functional and electrophysiological testing, is highly recommended.

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Cited by (73)

Cortical thickness of primary visual cortex correlates with motion deficits in periventricular leukomalacia
2021, Neuropsychologia
Citation Excerpt :
We selected 13 patients (mean ± SD, aged 11.2 ± 4.5 years, five males) from those referred to the Laboratory of Vision of the Fondazione Stella Maris. The inclusion criteria were 1) clear signs of periventricular leukomalacia (PVL) on perinatal brain ultrasounds and on MRI performed at later age, according to the criteria indicated in the literature (Cioni et al., 1992), 2) at least one brain MRI after 3 years of age, 3) good/normal or corrected-to-normal visual acuity, 4) absence of oculomotor dysfunctions and 5) good fixation and no spontaneous nystagmus. The last inclusion criterion is essential to avoid artefactual impairment on visual motion discrimination performance.
Impairments of visual motion perception and, in particular, of flow motion have been consistently observed in premature and very low birth weight subjects during infancy. Flow motion information is analyzed at various cortical levels along the dorsal pathways, with information mainly provided by primary and early visual cortex (V1, V2 and V3). We investigated the cortical stage of the visual processing that underlies these motion impairments, measuring Grey Matter Volume and Cortical Thickness in 13 children with Periventricular Leukomalacia (PVL). The cortical thickness, but not the grey matter volume of area V1, correlates negatively with motion coherence sensitivity, indicating that the thinner the cortex, the better the performance among the patients. However, we did not find any such association with either the thickness or volume of area MT, MST and areas of the IPS, suggesting damage at the level of primary visual cortex or along the optic radiation.
High-risk babies and neurodevelopmental outcome
2021, Diagnosis, Management and Modeling of Neurodevelopmental Disorders: The Neuroscience of Development
Babies who are exposed to high-risk factors during pregnancy, delivery, or immediately after birth are termed as high-risk babies. Preterm and birth-asphyxiated babies account for most of the high-risk babies, and these high-risk babies are at risk of adverse neurodevelopmental outcome. The adverse neurodevelopmental outcomes vary from mild motor and language delay to global delay, hearing and visual impairments, seizures and also long-term intellectual impairment, academic underachievement, and learning difficulties, thereby posing increased burden to family, society, and nation as well. Regular and close follow-up of any high-risk babies with early identification of any delay and early intervention with multidisciplinary approach will help to enhance the optimal development.
Relationship between brain structure and Cerebral Visual Impairment in children with Cerebral Palsy: A systematic review
2020, Research in Developmental Disabilities
Citation Excerpt :
Periventricular leucomalacia was the most common MRI finding reported followed by ventricular dilation, thinning of the corpus callosum and gliosis of the occipital area. Out of 30 studies reporting on white matter lesion, 24 studies (Arp & Fagard, 2005; Cioni, Bartalena, Biagioni, Boldrini, & Canapicchi, 1992; Fazzi et al., 2004; Fazzi et al., 2009; Galli et al., 2018; Guzzetta et al., 2001; Guzzetta et al., 2009; Ipata et al., 1994; Ito et al., 1996; Jacobson et al., 2010; Jacobson et al., 1996, 2002; Koeda & Takeshita, 1992; Lanzi et al., 1998; Ortibus et al., 2009; Pagliano et al., 2007; Pavlova et al., 2007; Qin et al., 2018; Salamon et al., 2014; Schatz et al., 2001; Schenk-Rootlieb et al., 1994; Skranes et al., 2008; Sie et al., 2005; Uggetti et al., 1996) accounting for 98.6 % (n = 656) of the subjects, presented with spastic CP. Cerebral Visual Impairment was reported in all the 30 studies, with dorsal stream dysfunction described in 9 studies (Arp & Fagard, 2005; Fazzi et al., 2004; Guzzetta et al., 2001, 2009; Jacobson et al., 1996, 2010; Ortibus et al., 2009; Schatz et al., 2001; Pavlova et al., 2007), both dorsal and ventral stream dysfunction in 4 studies (Fazzi et al., 2009; Galli et al., 2018; Jacobson et al., 2002; van Genderen et al., 2012) and remaining 17 studies did not specify the features of CVI assessed.
Cerebral Visual Impairment (CVI) is very common yet often unrecognised visual dysfunction in children with Cerebral Palsy (CP). Magnetic Resonance Imaging (MRI) is the diagnostic tool in the investigation of brain lesions in children with CP and CVI.
The aim of this systematic review is to evaluate the relationship between brain structure and CVI, as determined by MRI in children with CP.
A comprehensive search of 5 database (PubMed, EMBASE, SCOPUS, CINAHL and Cochrane Database) was undertaken up until June 2019. The PRISMA checklist was then utilised to report on the process of selecting eligible papers. A total of 30 observational studies met the full inclusion criteria. Further, STROBE checklist was employed to report on the observational studies.
Periventricular leucomalacia on MRI was found to have a strong association with CVI in all 30 studies. Only 13 (43 %) studies described dorsal and/ ventral stream dysfunction. There was ambiguity in the definition of CVI.
The overall level of evidence correlating different patterns of CVI and CP (based on GMFCS, motor type and distribution) and MRI was low. Further studies utilising advances in MRI are needed to understand brain reorganisation and patterns of CVI and suggest rehabilitation therapy inclusive of vision.
Perinatal undernutrition associated to experimental model of cerebral palsy increases adverse effects on chewing in young rats
2017, Physiology and Behavior
Citation Excerpt :
Undernutrition, especially protein undernutrition can result in changes in the maturation of the central nervous system, including impairments in the myelination [12] and in the development of neurological reflexes [13]. These damages in the nervous system are also observed in children with CP [14,15]. Thus, it is possible that poor nutritional status aggravates the primary effects of brain injury in children with cerebral palsy [16].
The aim of the present study was to investigate the effect of perinatal undernutrition on the sensorimotor pattern of chewing in rats submitted to cerebral palsy experimental model. A total of 60 male Wistar rats were randomly distributed into four groups: Nourished/Control (NC, n = 15), Nourished/Cerebral Palsy (NCP, n = 15); Undernourished/Control (UC, n = 15) and Undernourished/Cerebral Palsy (UCP, n = 15). Animals of cerebral palsy (CP) group were subjected to an experimental model based on the combination of perinatal anoxia associated with sensorimotor restriction of the hindlimb. In the rats were evaluated body weight gain, intake of breast milk, feed post-weaning consumption, parameters of the chewing, intra-oral sensitivity and muscle properties (muscle weight and distribution of types of fibers) of the masseter and digastric. Animals from undernourished CP group showed greater reduction in most data evaluated including body weight (P < 0.05), food intake post-weaning (P < 0.05), frequency of chewing cycles (P < 0.05), duration of the reactions of “taste” (P < 0.05), muscle weight and decrease of the proportion of type IIB fibers in the masseter muscle (P < 0.05). These results demonstrated in rats submitted a cerebral palsy that perinatal undernutrition intensifies the damage in morphological and functional parameters of chewing.
The assessment of visual acuity in children with periventricular damage: A comparison of behavioural and electrophysiological techniques
2008, Vision Research
It has been controversial whether electrophysiology offers better precision than behavioural techniques in measuring visual acuity in children with brain damage. We investigated the concordance between sweep VEPs and Acuity Cards (AC) in 29 children with periventricular leukomalacia (PVL), the most common type of brain damage in preterm infants. An overall good correlation was shown but with relatively better behavioural acuity values. VEP/AC ratio was significantly correlated to corpus callosum posterior thinning. We propose that this result reflects the efficacy of the compensatory mechanisms following early brain damage which may differentially affect the two methods.
Current perspective: Cerebral visual impairment-The impending doom
2023, Indian Journal of Ophthalmology

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View full text

Neuroimaging and functional outcome of neonatal leukomalacia

Early Hum. Dev.

Clin. Radiol.

Behav. Brain Res.

Lancet

Early Hum. Dev.

Early Hum. Dev.

Periventricular leukomalacia in infancy: a form of neonatal anoxic encephalopathy

Arch. Neurol.

Brain damage from perinatal asphyxia: correlation of MR findings with gestational age

Am. J. Neuroradiol.

Value of sonography in the diagnosis of intracranial hemorrhage and periventricular leukomalacia

Am. J. Radiol.

Dynamic EEG recordings of the preterm infant: relationship to intracranial haemorrhage

Boll. Lega It. Epil.

Brain before cognition: EEG maturation in preterm infants

Pathogenesis and evolution of periventricular leukomalacia in infancy

Arch. Neurol.

Neurological, electrophysiological and MRI abnormalities in infants with extensive cystic leukomalacia

Neuropediatrics

Cerebral ischaemic lesions

The neurological assessment of the preterm and fullterm newborn infant

Periventricular low attenuations: a normal finding in computerized topographic scans of neonates?

Arch. Neurol.

Correlation between computed tomography and autopsy in premature and full-term neonates that have suffered perinatal asphyxia

Radiology