Association between Lenticulostriate Vasculopathy (LSV) and Neonatal Intraventricular Hemorrhage (IVH)

Abstract

OBJECTIVES:To determine whether there is an unconfounded association between neonatal intraventricular hemorrhage (IVH) and lenticulostriate vasculopathy (LSV (also known as thalamostriate or mineralizing vasculopathy)). STUDY DESIGN:During the conduct of the Magnesium and Neurologic Endpoints Trial (MagNET), a randomized controlled trial involving maternal, hence fetal, exposure to antenatal magnesium sulfate in the context of preterm labor, head ultrasounds were obtained for each of the surviving neonates. Because of our previous experience in the diagnosis of LSV, when ascertaining the presence of IVH, as called for by the research protocol of our study, the presence or absence of LSV was also determined. RESULTS:We found LSV to be relatively prevalent (10% (14 of 140) among surviving babies). More importantly, it was significantly associated with the occurrence of neonatal IVH, even when controlled for possible confounding (adjusted OR 9.8, 95% confidence interval 1.3 to 73.1; p ¼ 0.03). CONCLUSION:Given the known relationships between IVH and neonatal morbidity and mortality, the finding of a statistically significant association between neonatal IVH and LSV may suggest more substantial implications for the latter than previously believed.

Neonatal Lupus Erythematosus

“…Less common radiological findings in infants who had NLS include thalamostriatal malformations, absent septum pellucidum, prominent cavum septum pellucidum, optic chiasm and optic nerve hypoplasia, and cortical dysgenesis. A statistically significant association has been observed between neonatal intraventricular hemorrhage and lenticulostriate vasculopathy in infants with NLS [66]. The prevalence of hydrocephalus and macrocephaly also is increased in infants born to mothers who have anti-SSA/Ro antibodies [63].…”

Diffuse basal ganglia or thalamus hyperechogenicity in preterm infants

“…In Paczko's study, 6 hyperechogenicity of thalamic vessels was associated with increasing GA and birth weight, breech presentation and seizures. In Mittendorf's post hoc analysis of the MagNET trial (randomized magnesium administration for preterm labour at >24 and <34 weeks), 14,15 lenticulostriate vasculopathy (linear BGTH) was associated with placental funisitis and IVH using univariate analysis, and with high-maternal dose of magnesium (X50 g) using multivariate analysis. Linear or punctuate BGTH, although often associated with lenticulostriate vasculopathy (with basophilic deposits in arterial walls, perivascular infiltrates and mineralizing coagulative necrosis), 1,11 may occur in the absence of pathologic vascular or perivascular anomalies.…”

“…1,2,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Basal ganglia hemorrhage results from periventricular hemorrhagic infarction or hemorrhagic necrosis. In preterm infants <28 weeks, diffuse caudate hemorrhage is difficult to differentiate from hemorrhage in the germinal matrix over the body of the caudate nucleus (grade I).…”

Brain lesions in newborns exposed to high-dose magnesium sulfate during preterm labor

“…2 Second, IVH is strongly associated with lenticulostriate vasculopathy (LSV), an unusual mineralizing lesion involving the thalami and basal ganglia of the neonate. 3 Third, exposure to 50 g or more of tocolytic MgSO 4 during preterm labor is associated with the development of LSV. 4 Of interest, doses of MgSO 4 in this range, such as those used in tocolysis, have also been shown to be associated with total pediatric mortality in the Cochrane Database of Systematic Reviews (relative risk (RR), 2.82, 95% CI 1.2-6.6).…”