Periventricular haemorrhagic infarct in a preterm neonate

doi:10.1053/ejpn.1999.0175

European Journal of Paediatric Neurology

Volume 3, Issue 1, January 1999, Pages 25-28

https://doi.org/10.1053/ejpn.1999.0175 Get rights and content

Abstract

Magnetic resonance imaging (MRI) was performed on an infant born at 28 weeks gestational age who suffered a sudden episode of bradycardia and desaturation on the 3rd day of life. Imaging demonstrated bilateral germinal layer haemorrhage and intraventricular haemorrhage, with parenchymal involvement in a fan-shaped pattern in the periventricular white matter on the left. These appearances are consistent with a combination of intravascular thrombi and perivascular haemorrhage along the course of the medullary veins. We believe that this is the first report of the MRI appearance of an acute periventricular haemorrhagic infarct associated with a germinal layer haemorrhage/intraventricular haemorrhage in a preterm neonate.

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Cited by (31)

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Citation Excerpt :
Doppler ultrasound has shown reduced blood flow velocity in the terminal vein on the affected side (Taylor, 1995), suggesting impaired venous drainage. The periventricular hemorrhage is shown as a fan-shaped structure, due to obstructed medullary veins, of low signal intensity on T2-weighted imaging (Haddad et al., 1992; Counsell et al., 1999). Parenchymal hemorrhagic infarction results in interruption of projection and association fibers and oligodendroglial damage, which disrupts myelination.
Magnetic resonance imaging (MRI) can provide detail of the soft tissues of the fetal and neonatal brain that cannot be obtained by any other imaging modality. Conventional T1 and T2 weighted sequences provide anatomic detail of the normally developing brain and can demonstrate lesions, including those associated with preterm birth, hypoxic ischemic encephalopathy, perinatal arterial stroke, infections, and congenital malformations. Specialized imaging techniques can be used to assess cerebral vasculature (magnetic resonance angiography and venography), cerebral metabolism (magnetic resonance spectroscopy), cerebral perfusion (arterial spin labeling), and function (functional MRI). A wealth of quantitative tools, most of which were originally developed for the adult brain, can be applied to study the developing brain in utero and postnatally including measures of tissue microstructure obtained from diffusion MRI, morphometric studies to measure whole brain and regional tissue volumes, and automated approaches to study cortical folding. In this chapter, we aim to describe different imaging approaches for the fetal and neonatal brain, and to discuss their use in a range of clinical applications.
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2018, Volpe's Neurology of the Newborn
Germinal matrix hemorrhage–intraventricular hemorrhage (GMH-IVH) is the most common variety of neonatal intracranial hemorrhage and is characteristic of the premature infant. This form of brain injury affects around 25% of all very low birthweight (<1500 g) premature infants, resulting in an increased risk for neurodevelopmental disability. Its occurrence can lead to impact on subsequent brain development because of destruction of the immature germinal cerebral region resulting in loss of progenitor cells, acceleration of white matter injury via pressure and oxidative stress, and direct parenchymal injury. Finally, hydrocephalus can complicate IVH, resulting in a further increased risk of neurodevelopmental disability. In this chapter, the neuropathology, pathogenesis, clinical features, diagnosis, prognosis, and management of IVH, and its complications will be reviewed. The prominent position of this lesion in neonatal medicine has been accompanied by a large increase in work from several disciplines. This chapter attempts to integrate this information in a meaningful way without oversimplifying a clearly complex problem.
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Doppler ultrasound can also be used for the imaging and flow velocity measurements of the terminal vein that is implicated in PVHI, but the clinical importance of this application remains undetermined. Although the superiority of MRI over CUS for the detection of associated white matter abnormalities and smaller size petechial hemorrhages is well recognized,24 its use in the early critical period during the first days of life25,26 is currently hindered by its limited availability, the logistics of transportation, concerns over sedation, and the high cost. These limitations hamper the clinical use of desirable sequences, such as diffusion, spectroscopy, and MR angiography, for the prediction and early detection of GM-IVH and its complications.
MRI of the newborn brain
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Preterm infants may have lesions within the cerebral parenchymal such as periventricular leucomalacia, haemorrhagic parenchymal infarction or intraventricular haemorrhage with or without dilatation. Haemorrhagic infarction is seen as a fan-shaped area of low signal intensity surrounded by relative high signal intensity on T2-weighted imaging (Figure 11a).26 This area then undergoes cystic degeneration to form a porencephalic cyst by term age.27
MRI is an essential tool in the assessment and care of term neonates with suspected brain injury. It also provides insights into brain development and injury in preterm infants. Successful neonatal brain imaging requires modifications to the hardware and sequences used in adults, particularly if using higher magnet strengths. Different types of sequences give information on the macroscopic and microscopic structure of the brain. Qualitative analysis can detect patterns of injury and provide valuable information on prognosis; quantitative analysis can give more detailed and subtle information of brain structures. MRI can be used as a biomarker of brain injury in term-born infants, enabling the efficacy of neuroprotective agents (e.g. hypothermia) to be assessed. Exciting recent developments in fetal imaging allow study of normal brain development even before birth.

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^f1: Correspondence: Ms S J Counsell, MRI Unit, Hammersmith Hospital, DuCane Road, London W12 0HS, UK

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Case StudyPeriventricular haemorrhagic infarct in a preterm neonate

Abstract

Case Study
Periventricular haemorrhagic infarct in a preterm neonate