Neuroradiological Mimics of Periventricular Leukomalacia

2021 ◽  
pp. 088307382110260
Author(s):  
Nihaal Reddy ◽  
Mary Doyle ◽  
Prasad Hanagandi ◽  
Ajay Taranath ◽  
Hisham Dahmoush ◽  
...  
Keyword(s):  
White Matter ◽  
Neurological Disorder ◽  
Clinical Presentation ◽  
Periventricular Leukomalacia ◽  
Brain Mri ◽  
White Matter Injury ◽  
Healthy Children ◽  
Imaging Features ◽  
Inherited Disorders ◽  
Radiological Criteria

Aim: Periventricular leukomalacia (PVL) is a term reserved to describe white matter injury in the premature brain. In this review article, the authors highlight the common and rare pathologies mimicking the chronic stage of PVL and propose practical clinico-radiological criteria that would aid in diagnosis and management. Methods and Results: The authors first describe the typical brain MRI (magnetic resonance imaging) features of PVL. Based on their clinical presentation, pathologic entities and their neuroimaging findings were clustered into distinct categories. Three clinical subgroups were identified: healthy children, children with stable/nonprogressive neurological disorder, and those with progressive neurological disorder. The neuroradiological discriminators are described in each subgroup with relevant differential diagnoses. The mimics were broadly classified into normal variants, acquired, and inherited disorders. Conclusions: The term “PVL” should be used appropriately as it reflects its pathomechanism. The phrase “white matter injury of prematurity” or “brain injury of prematurity” is more specific. Discrepancies in imaging and clinical presentation must be tread with caution and warrant further investigations to exclude other possibilities.

scholarly journals Factors associated with neurodevelopment in preterm infants with systematic inflammation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eun Sun Lee ◽  
Ee-Kyung Kim ◽  
Seung han Shin ◽  
Young-Hun Choi ◽  
Young Hwa Jung ◽  
...  
Keyword(s):  
White Matter ◽  
Preterm Infants ◽  
Systemic Inflammation ◽  
Head Circumference ◽  
Brain Mri ◽  
White Matter Injury ◽  
Social Emotional ◽  
Postmenstrual Age ◽  
Neurodevelopmental Impairment ◽  
Near Term

Abstract Background Several studies have suggested that adverse neurodevelopment could be induced by systemic inflammation in preterm infants. We aimed to investigate whether preterm infants with systemic inflammation would have impaired neurodevelopment and which biomarkers and neurophysiologic studies during inflammation are associated with poor neurodevelopment. Methods This prospective cohort study enrolled infants born before 30 weeks of gestation or with birth weight < 1250 g. Infants were grouped according to the presence of systemic inflammation: Control (no inflammation, n = 49), I (systemic inflammation, n = 45). Blood and cerebrospinal fluid samples for markers of brain injury and inflammation were collected and amplitude-integrated electroencephalography (aEEG) was performed within 4 h of septic workup. We evaluated aEEG at 35 weeks postmenstrual age (PMA), head circumference at 36 weeks PMA, and brain MRI at discharge. The Bayley Scales of Infant and Toddler Development III (Bayley-III) was performed at a corrected age (CA) of 18 months. Results The I group had more white matter injuries (2 vs. 26.7%, Control vs. I, respectively) at the time of discharge, lower brain functional maturation (9.5 vs. 8), and smaller head size (z-score − 1.45 vs. -2.12) at near-term age and poorer neurodevelopment at a CA of 18 months than the control (p < 0.05). Among the I group, the proportion of immature neutrophils (I/T ratios) and IL-1 beta levels in the CSF were associated with aEEG measures at the day of symptom onset (D0). Seizure spike on aEEG at D0 was significantly correlated with motor and social-emotional domains of Bayley-III (p < 0.05). The I/T ratio and CRP and TNF-α levels of blood at D0, white matter injury on MRI at discharge, head circumference and seizure spikes on aEEG at near-term age were associated with Bayley-III scores at a CA of 18 months. Conclusions Systemic inflammation induced by clinical infection and NEC are associated with neurodevelopmental impairment in preterm infants. The seizure spike on aEEG, elevated I/T ratio, CRP, and plasma TNF-alpha during inflammatory episodes are associated with poor neurodevelopment.

scholarly journals Chloride cotransporter NKCC1 inhibitor bumetanide protects against white matter injury in a rodent model of periventricular leukomalacia

2015 ◽  
Vol 77 (4) ◽  
pp. 554-562 ◽  
Author(s):  
Lauren L. Jantzie ◽  
Melody Y. Hu ◽  
Hyun-Kyung Park ◽  
Michele C. Jackson ◽  
Jenny Yu ◽  
...  
Keyword(s):  
White Matter ◽  
Periventricular Leukomalacia ◽  
Rodent Model ◽  
White Matter Injury

scholarly journals NMDA Receptor Blockade with Memantine Attenuates White Matter Injury in a Rat Model of Periventricular Leukomalacia

2008 ◽  
Vol 28 (26) ◽  
pp. 6670-6678 ◽  
Author(s):  
S. M. Manning ◽  
D. M. Talos ◽  
C. Zhou ◽  
D. B. Selip ◽  
H.-K. Park ◽  
...  
Keyword(s):  
White Matter ◽  
Nmda Receptor ◽  
Rat Model ◽  
Periventricular Leukomalacia ◽  
White Matter Injury ◽  
Receptor Blockade ◽  
Nmda Receptor Blockade

scholarly journals Developmental regulation of group I metabotropic glutamate receptors in the premature brain and their protective role in a rodent model of periventricular leukomalacia

2010 ◽  
Vol 6 (4) ◽  
pp. 277-288 ◽  
Author(s):  
Lauren L. Jantzie ◽  
Delia M. Talos ◽  
Debra B. Selip ◽  
Li An ◽  
Michele C. Jackson ◽  
...  
Keyword(s):  
White Matter ◽  
Glutamate Receptors ◽  
Metabotropic Glutamate Receptor ◽  
Periventricular Leukomalacia ◽  
Rodent Model ◽  
White Matter Injury ◽  
Cerebral White Matter ◽  
Metabotropic Glutamate ◽  
Group I ◽  
Group I Mglurs

Cerebral white matter injury in premature infants, known as periventricular leukomalacia (PVL), is common after hypoxia–ischemia (HI). While ionotropic glutamate receptors (iGluRs) can mediate immature white matter injury, we have previously shown that excitotoxic injury to premyelinating oligodendrocytes (preOLs) in vitro can be attenuated by group I metabotropic glutamate receptor (mGluR) agonists. Thus, we evaluated mGluR expression in developing white matter in rat and human brain, and tested the protective efficacy of a central nervous system (CNS)-penetrating mGluR agonist on injury to developing oligodendrocytes (OLs) in vivo. Group I mGluRs (mGluR1 and mGluR5) were strongly expressed on OLs in neonatal rodent cerebral white matter throughout normal development, with highest expression early in development on preOLs. Specifically at P6, mGluR1 and mGLuR5 were most highly expressed on GalC-positive OLs compared to neurons, axons, astrocytes and microglia. Systemic administration of (1S,3R) 1-aminocyclopentane-trans-1,3,-dicarboxylic acid (ACPD) significantly attenuated the loss of myelin basic protein in the white matter following HI in P6 rats. Assessment of postmortem human tissue showed both mGluR1 and mGluR5 localized on immature OLs in white matter throughout development, with mGluR5 highest in the preterm period. These data indicate group I mGluRs are highly expressed on OLs during the peak period of vulnerability to HI and modulation of mGluRs is protective in a rodent model of PVL. Group I mGluRs may represent important therapeutic targets for protection from HI-mediated white matter injury.

Associative learning in children with perinatal brain injury

1997 ◽  
Vol 3 (6) ◽  
pp. 521-527 ◽  
Author(s):  
JEFFREY SCHATZ ◽  
SUZANNE CRAFT ◽  
MYLES KOBY ◽  
T.S. PARK
Keyword(s):  
White Matter ◽  
Associative Learning ◽  
Paired Associate ◽  
Statistical Significance ◽  
White Matter Injury ◽  
Periventricular White Matter ◽  
Healthy Children ◽  
Perinatal Brain Injury ◽  
Associate Learning ◽  
Lesion Severity

Associate learning for visual nonverbal and auditory verbal items was examined in 21 children with spastic diplegic cerebral palsy (SDCP) and 28 healthy children using four paired associate tasks. SDCP children showed poorer performance than the comparison group for learning pairs that required visual nonverbal responses, regardless of the stimulus modality. Within the SDCP group, lesion severity was assessed in 17 of the children. Lesion severity was related to the level of performance on paired associate tasks requiring visual nonverbal responses; lesion severity did not reach statistical significance for tasks requiring auditory verbal responses. The study suggests: (1) periventricular white matter regions are important for the development of basic learning processes, such as associative learning, and (2) learning of visual nonverbal material is disproportionately affected following white matter injury early in life. (JINS, 1997, 3, 521–527.)

scholarly journals Acute necrotizing encephalopathy of childhood. Diagnostic and treatment challenges in COVID-19 pandemic

2020 ◽  
Vol 48 ◽  
pp. 32-36
Author(s):  
V. E. Kitaeva ◽  
A. S. Kotov
Keyword(s):  
Cerebrospinal Fluid ◽  
White Matter ◽  
Respiratory Infection ◽  
Protein Level ◽  
Brain Mri ◽  
Healthy Children ◽  
Acute Necrotizing Encephalopathy ◽  
The Third ◽  
Acute Necrotizing ◽  
Bilateral Lesions

Acute necrotizing encephalopathy of childhood (ANEC) can occur in previously healthy children during a respiratory infection with fever and can manifest by epileptic seizures. Magnetic resonance imaging (MRI) typically shows bilateral lesions of the brainstem, cerebellum, thalamuses, basal neclei, and hemispheral white matter. We describe three clinical cases with an initial diagnosis of ANEC. In the first case, a 12-year old patient developed headache, leg weakness and high blood pressure during treatment of hepatitis C virus infection with PEG-interferon alfa2b. Later on she had myoclonic seizures with subsequent epileptic status, tetraparesis, confusion, and hyperthermia. Her clinical chemistry parameters showed a non-significant increase in liver enzymes levels. Cerebrospinal fluid was remarkable for increased protein level. The patient's brain MRI showed typical for ANEC bilateral thalamic lesions. The second case manifested with myoclonic seizures and subsequent epileptic status in a 17-months' old patient with a respiratory infection (vomiting, rhinitis, fever, and hyperthermia). His brain MRI showed bilateral lesions in the brainstem (dorsal part of the pons), thalamus, subcortical nuclei, white matter of the cerebral hemispheres, as well as lesions in the left hippocampus. The patient had increased urine levels of malic, 2-hydroxyisovalerianic, 3-hydroxy-isovalerianic, N-acetylaspartic, 3-hydroxybutyric, and lactic acids and increased blood levels of alanine, glutamic acid, glycine, and ornithine. By the time of the study, no hereditary metabolic disease was identified. In the third case, a 3-year old patient with a respiratory infection with vomiting and fever developed left-sided hemiparesis after she had fallen out of bed. The brain MRI revealed acute ischemic damage. Her cerebrospinal fluid was remarkable for a decreased protein level. Currently, ANEC is a diagnosis of exclusion. In the third patient, ANEC was obviously misdiagnosed. It is necessary to clarify the diagnostic criteria for the syndrome and to develop a management protocol for patients with ANEC.

scholarly journals An Important Finding of White Matter Injury in Late Preterm Infant: Deep Medullary Vein Involvement

2020 ◽  
Vol 8 ◽  
Author(s):  
Dan Chen ◽  
Jing Sun ◽  
Qiuyu Li ◽  
Wenjuan Bai ◽  
Jian Mao
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
High Risk ◽  
Preterm Infants ◽  
Periventricular Leukomalacia ◽  
Late Preterm ◽  
White Matter Injury ◽  
Late Preterm Infants ◽  
High Risk Factors ◽  
Mri Features

Objective: To investigate high risk factors and magnetic resonance imaging (MRI) features in late preterm infants with severe white matter injury (WMI) associated with abnormal deep medullary veins (DMVs).Materials and Methods: Preterm infants with severe WMI, who were hospitalized in Shengjing Hospital from 1st January 2009 to 31st December 2018, were enrolled in this retrospective study. High risk factors and MRI characteristics of infants with abnormal DMVs were analyzed and compared with those of infants without DMV abnormalities.Results: A total of 2032 late preterm infants were examined by MRI; 71 cases (3.5%) had severe WMI and 15 of these (21.1%) had abnormal DMVs. The incidence of maternal diabetes was higher in infants with abnormal DMVs and neonatal convulsions were more likely (P &lt; 0.05). The incidence of grade IV injury (P &lt; 0.05), white matter periventricular cysts and thalamic injury (P &lt; 0.01), cerebral venous sinus thrombus (P &lt; 0.01) and germinal matrix/intraventricular hemorrhage (P &lt; 0.05) were higher in infants with abnormal DMVs than in infants with normal DMVs.Conclusions: Congestion/thrombosis of DMVs may be an important cause of severe WMI in late preterm infants, especially in periventricular leukomalacia-like WMI. WMI with abnormal DMVs is more likely to lead to thalamic injury.

scholarly journals Regional Differences in Susceptibility to Hypoxic-Ischemic Injury in the Preterm Brain: Exploring the Spectrum from White Matter Loss to Selective Grey Matter Injury in a Rat Model

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
D. B. Selip ◽  
L. L. Jantzie ◽  
M. Chang ◽  
M. C. Jackson ◽  
E. C. Fitzgerald ◽  
...  
Keyword(s):  
Brain Injury ◽  
White Matter ◽  
Rat Model ◽  
Grey Matter ◽  
Very Low Birth Weight ◽  
Neuronal Degeneration ◽  
Periventricular Leukomalacia ◽  
White Matter Injury ◽  
Injury Patterns ◽  
Grey Matter Injury

Models of premature brain injury have largely focused on the white matter injury thought to underlie periventricular leukomalacia (PVL). However, with increased survival of very low birth weight infants, injury patterns involving grey matter are now recognized. We aimed to determine how grey matter lesions relate to hypoxic-ischemic- (HI) mediated white matter injury by modifying our rat model of PVL. Following HI, microglial infiltration, astrocytosis, and neuronal and axonal degeneration increased in a region-specific manner dependent on the severity of myelin loss in pericallosal white matter. The spectrum of injury ranged from mild, where diffuse white matter abnormalities were dominant and were associated with mild axonal injury and local microglial activation, to severe HI injury characterized by focal MBP loss, widespread neuronal degeneration, axonal damage, and gliosis throughout the neocortex, caudate putamen, and thalamus. In sum, selective regional white matter loss occurs in the preterm rat concomitantly with a clinically relevant spectrum of grey matter injury. These data demonstrate an interspecies similarity of brain injury patterns and further substantiates the reliable use of this model for the study of preterm brain injury.

Sign in / Sign up

Export Citation Format

Share Document