Imaging diagnosis and legal implications of brain injury in survivors following single intrauterine fetal demise from monochorionic twins – a review of the literature

Abstract Brain injury of the surviving twin from monochorionic pregnancies following intrauterine fetal demise during the second and third trimesters is a rare but severe complication. Monochorionicity and gestational age at the time of stillbirth seem to be decisive factors in terms of long-term neurologic outcome prediction for the survivor. Magnetic resonance imaging (MRI), diffusion weighted imaging (DWI) in particular, seem to bring the earliest and most accurate diagnosis. Ultrasound detection of brain damage is possible in later stages of fetal brain injury. It is essential to provide early diagnosis and multidisciplinary counsel to the parents to ensure informed decision making. For couples who choose to terminate pregnancy legislation related to late abortion might lead to further distress. Our paper aims to stress the importance of MRI DWI in the evaluation of surviving twins following single intrauterine fetal demise in monochorionic pregnancies and the delicate context of the medical professionals and parents facing this clinical situation, sometimes complicated by legal constraints.

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CEREBRAL PALSY:A CLINICAL OVERVIEW

JOURNAL OF NEUROLOGY AND NEUROSURGICAL RESEARCH ◽

10.26739/2181-0982-2020-3-12 ◽

2020 ◽

Vol 3 (1) ◽

pp. 54-59

Author(s):

Nargiza Ergasheva ◽

◽

Sardor Anorboev ◽

Gavkhar Kendjaeva ◽

Keyword(s):

Brain Area ◽

Fetal Brain ◽

Clinical History ◽

Screening Tests ◽

Spastic Diplegia ◽

Team Approach ◽

Birth Process ◽

Increased Risk ◽

Spastic Quadriplegia ◽

Magnetic Resonance Imaging Mri

Cerebral palsy (CP) is a disorder characterized by abnormal tone, posture and movement. The incidence of CP is 2–4 per 1,000 live births in the world. Prematurityand low birth weight are important risk factors for CP; however, multiple other factors have been associated with an increased risk for CP, including maternal infections and diseases, and abnormal birth process. In most cases of CP the initial injury to the brain occurs during early fetal brain development, later a brain area that is injured cannot function properly in the future. CP is classified clinically based on the predominant motor syndrome—spastic hemiplegia, spastic diplegia, spastic quadriplegia, ataxic and dyskinetic cerebral palsies. The diagnosis of CPis based on a combination of clinical history, use of standardized neuromotor assessment and findings on magnetic resonance imaging (MRI). If there is a suspicionof genetic or inborn metabolic disorders, screening tests should be provided additionally. Because CP is associated with multiple associated and secondary medical conditions, its management requires a multidisciplinary team approach

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Statistical Estimation of Accelerated Biological Brain Aging After Mild Traumatic Brain Injury in Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.3282 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 890-890

Author(s):

Andrei Irimia ◽

Jun Kim ◽

Shania Wang ◽

Hyung Jun Lee ◽

Van Ngo ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Brain Aging ◽

Rate Of Change ◽

Time Period ◽

Weighted Magnetic Resonance Imaging ◽

Neurological Conditions ◽

Magnetic Resonance Imaging Mri ◽

Brain Age

Abstract Estimating biological brain age (BA) has the potential of identifying individuals at relatively high risk for accelerated neurodegeneration. This study compares the brain’s chronological age (CA) to its BA and reveals the BA rate of change after mild traumatic brain injury (mTBI) in an aging cohort. Using T1-weighted magnetic resonance imaging (MRI) volumes and cortical thickness, volume, surface area, and Gaussian curvature obtained using FreeSurfer software; we formulated a multivariate linear regression to determine the rate of BA increase associated with mTBI. 95 TBI patients (age in years (y): μ = 41 y, σ = 17 y; range = 18 to 83) were compared to 462 healthy controls (HCs) (age: μ = 69 y, σ = 18 y; range = 25 to 95) over a 6-month time period following mTBI. Across the initial ~6 months following injury, patients’ BAs increased by ~3.0 ± 1.2 years due to their mTBIs alone, i.e., above and beyond typical brain aging. The superior temporal and parahippocampal gyri, two structures involved in memory formation and retrieval, exhibited the fastest rates of TBI-related BA. In both hemispheres, the volume of the hippocampus decreased (left: μ=0.28%, σ=4.40%; right: μ=0.12%, σ=4.84%). These findings illustrate BA estimation techniques’ potential to identify TBI patients with accelerated neurodegeneration, whose rate is strongly associated with the risk for dementia and other aging-related neurological conditions.

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Associations of Binge Drinking With Vascular Brain Injury and Atrophy in Older American Indians: The Strong Heart Study

Journal of Aging and Health ◽

10.1177/08982643211013696 ◽

2021 ◽

Vol 33 (7-8_suppl) ◽

pp. 51S-59S

Author(s):

Jordan P. Lewis ◽

Astrid M. Suchy-Dicey ◽

Carolyn Noonan ◽

Valarie Blue Bird Jernigan ◽

Jason G. Umans ◽

...

Keyword(s):

Brain Injury ◽

Binge Drinking ◽

American Indians ◽

Multiple Time ◽

Heart Study ◽

Neurological Risk ◽

The Us ◽

Large Cohort Study ◽

Magnetic Resonance Imaging Mri ◽

Multiple Time Points

Objectives: American Indians (AIs) generally consume less alcohol than the US general population; however, the prevalence of alcohol use disorder is higher. This is the first large cohort study to examine binge drinking as a risk factor for vascular brain injury (VBI). Methods: We used linear and Poisson regression to examine the association of self-reported binge drinking with VBI, measured via magnetic resonance imaging (MRI), in 817 older AIs who participated in the Strong Heart and Cerebrovascular Disease and Its Consequences in American Indians studies. Results: Any binge drinking at multiple time-points was associated with increased sulcal (β = 0.360, 95% CI [0.079, 0.641]) and ventricle dilatation (β = 0.512, 95% CI [0.174, 0.850]) compared to no binge drinking. Discussion: These observed associations are consistent with previous findings. Identifying how binge drinking may contribute to VBI in older AIs may suggest modifiable health behaviors for neurological risk reduction and disease prevention.

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Florid Bacillus cereus Infection of the Placenta Associated With Intrauterine Fetal Demise

Pediatric and Developmental Pathology ◽

10.1177/1093526621999026 ◽

2021 ◽

pp. 109352662199902

Author(s):

Stephanie Shea ◽

Alberto Paniz-Mondolfi ◽

Emilia Sordillo ◽

Michael Nowak ◽

Fumiko Dekio

Keyword(s):

Bacillus Cereus ◽

Placental Tissue ◽

Maternal Blood ◽

Gastrointestinal Infections ◽

Gram Positive ◽

Fetal Demise ◽

Placental Infection ◽

Intrauterine Fetal Demise ◽

Acute Necrotizing ◽

Poor Outcomes

Bacillus cereus is a gram-positive, rod-shaped bacterium that is commonly implicated in foodborne illness but has also become increasingly recognized as a source of serious non-gastrointestinal infections, including sepsis, meningitis, and pneumonia. Non-gastrointestinal B. cereus infections have been identified in children, especially in neonates; however, there are no previously described cases of fetal demise associated with B. cereus placental infection. We present a case of acute chorioamnionitis-related intrauterine fetal demise of twin A at 17 weeks gestation, noted two days after selective termination of twin B. Histological examination revealed numerous gram-positive bacilli in placental tissue, as well as fetal vasculature, in the setting of severe acute necrotizing chorioamnionitis and subchorionitis, intervillous abscesses, acute villitis, and peripheral acute funisitis. Cultures of maternal blood and placental tissue both yielded growth of B. cereus. This case underscores the importance of B. cereus as a human pathogen, and specifically demonstrates its potential as an agent of severe intraamniotic and placental infection with poor outcomes for the fetus.

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Intrapartum Basal Ganglia–Thalamic Pattern Injury and Radiologically Termed “Acute Profound Hypoxic–Ischemic Brain Injury” Are Not Synonymous

American Journal of Perinatology ◽

10.1055/s-0040-1721692 ◽

2020 ◽

Author(s):

Johan Smith ◽

Regan Solomons ◽

Lindi Vollmer ◽

Eduard J. Langenegger ◽

Jan W. Lotz ◽

...

Keyword(s):

Brain Injury ◽

Basal Ganglia ◽

Caesarean Section ◽

Median Time ◽

Mode Of Delivery ◽

Time Interval ◽

Key Points ◽

Admission Status ◽

Sentinel Event ◽

Magnetic Resonance Imaging Mri

Objective Human cases of acute profound hypoxic-ischemic (HI) injury (HII), in which the insult duration timed with precision had been identified, remains rare, and there is often uncertainty of the prior state of fetal health. Study Design A retrospective analysis of 10 medicolegal cases of neonatal encephalopathy-cerebral palsy survivors who sustained intrapartum HI basal ganglia-thalamic (BGT) pattern injury in the absence of an obstetric sentinel event. Results Cardiotocography (CTG) admission status was reassuring in six and suspicious in four of the cases. The median time from assessment by admission CTG or auscultation to birth was 687.5 minutes (interquartile range [IQR]: 373.5–817.5 minutes), while the median time interval between first pathological CTG and delivery of the infant was 179 minutes (IQR: 137–199.25 minutes). The mode of delivery in the majority of infants (60%) was by unassisted vaginal birth; four were delivered by delayed caesarean section. The median (IQR) interval between the decision to perform a caesarean section and delivery was 169 minutes (range: 124–192.5 minutes). Conclusion The study shows that if a nonreassuring fetal status develops during labor and is prolonged, a BGT pattern HI injury may result, in the absence of a perinatal sentinel event. Intrapartum BGT pattern injury and radiologically termed “acute profound HI brain injury” are not necessarily synonymous. A visualized magnetic resonance imaging (MRI) pattern should preferably solely reflect the patterns description and severity, rather than a causative mechanism of injury. Key Points

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Coxsackie Virus A16 Infection of Placenta with Massive Perivillous Fibrin Deposition Leading to Intrauterine Fetal Demise at 36 Weeks Gestation

Pediatric and Developmental Pathology ◽

10.2350/15-01-1603-cr.1 ◽

2015 ◽

Vol 18 (4) ◽

pp. 331-334 ◽

Cited By ~ 19

Author(s):

Weiming Yu ◽

Raymond Tellier ◽

James R. Wright

Keyword(s):

Coxsackie Virus ◽

Fibrin Deposition ◽

Fetal Demise ◽

Intrauterine Fetal Demise

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Structural and Neurochemical Markers of Brain Injury in the Migraine Diathesis of Systemic Lupus Erythematosus

Cephalalgia ◽

10.1046/j.1468-2982.1998.1804209.x ◽

1998 ◽

Vol 18 (4) ◽

pp. 209-215 ◽

Cited By ~ 24

Author(s):

CL Rozell ◽

WL Sibbitt ◽

WM Brooks

Keyword(s):

Systemic Lupus Erythematosus ◽

Brain Injury ◽

Disease Activity ◽

Lupus Erythematosus ◽

Migraine Headache ◽

Organ Involvement ◽

Systemic Lupus ◽

Recurrent Headache ◽

Patients At Risk ◽

Magnetic Resonance Imaging Mri

Objective: To determine whether migraine in systemic lupus erythematosus (SLE) is associated with accentuated brain injury and disease activity. Methods: Forty SLE patients (11 without headache, 11 with non-migraine headache, and 18 with migraine) underwent clinical evaluation, magnetic resonance imaging (MRI), and spectroscopy (MRS). Results: Recurrent headache occurred in 75% of SLE patients. MRI abnormalities and reduced N-acetylaspartate were common. However, migraine in SLE was not associated with increased disease activity or severity, neuropsychiatrie manifestations, or end-organ involvement compared to patients without migraine ( p>0.05). There were no differences in the prevalence or severity of MRI or MRS abnormalities between SLE patients with migraine, with non-migraine headache, or without headache ( p>0.05). Conclusions: Headache does not identify SLE patients at risk for brain injury, increased disease activity, or increased end-organ involvement. Aggressive immunosuppressive therapy for headache alone is not indicated in SLE.

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