Is Routine TORCH Screening Warranted in Neonates with Lenticulostriate Vasculopathy?

Abstract

Background: Congenital infections are associated with a wide spectrum of clinical symptoms, including lenticulostriate vasculopathy (LSV). Objective: To determine the relationship between LSV and congenital infections, as diagnosed by TORCH serology and viral culture for cytomegalovirus (CMV). Methods: All neonates with LSV admitted to our neonatal intensive-care unit from 2004 to 2008 were included in the study. Results of maternal and neonatal TORCH testing were evaluated. Results: During the study period, cranial ultrasound scans were performed in 2,088 neonates. LSV was detected in 80 (4%) neonates. Maternal and/or neonatal serological TORCH tests were performed in 73% (58/80) of cases. None of the mothers or infants (0 of 58) had positive IgM titres for Toxoplasma, rubella, CMV or herpes simplex virus. Additional urine culture for CMV was performed in 38 neonates. None of the infants (0 of 38) had a positive CMV urine culture test. Conclusions: Routinely applied efforts to diagnose congenital infections in cases presenting with LSV have a poor yield. Routine TORCH screening in neonates with LSV cases should only be regarded as mandatory once well-designed studies demonstrate a clear diagnostic benefit.

The etiology of lenticulostriate vasculopathy and the role of congenital infections

“…In the same report, authors summarized 10 prior studies evaluating congenital infections in neonates with LSV. In this series, the overall incidence of congenital infections was 7% (32/442) of all neonates tested for infection [54]. Another review of 70 infants found 3 infants with congenital infection (4%, 2 HIV-infected, 1 congenital toxoplasmosis) [14].…”

“…As a result, routine screening for congenital infections in infants with LSV has fallen out of favor [9]. de Jong et al [54] reviewed 80 infants with LSV cared for in their neonatal intensive care unit during a 5-year period and did not find evidence of congenital infection in any of them. In the same report, authors summarized 10 prior studies evaluating congenital infections in neonates with LSV.…”

Lenticulostriate vasculopathy in neonates: Is it a marker of cerebral insult? Critical review of the literature

“…For example, LSV has been reported to be present on 0.4% of screening cranial ultrasounds in all neonates admitted to the NICU [18], 0.3-4% in neonates who had an ultrasound scan for a clinical indications [3,13,[19][20][21][22] and 5-32% in preterm neonates receiving an ultrasound scan to screen for suspected pathology [5,[23][24][25][26]]. An upward trend in incidence has been reported in recent studies [5,26,27], which might reflect nothing more than a growing awareness of this finding on neonatal cranial ultrasound.…”

“…To date, most published reports of LSV are retrospective reviews [6,11,13,[19][20][21]23,24,28,29] or case reports of varying size [7,14,16,[30][31][32][33][34][35][36][37][38] with the diagnosis frequently made by a single radiologist without confirmation. Existing prospective studies are limited in number and sample size, resulting in conflicting observations and conclusions [18,22,26].…”

New perspectives on lenticulostriate vasculopathy in neonates

“…This resulted in the recommendation that all neonates with LSV should be screened for congenital infection. However, since then, several studies questioned this association and failed to show the same results [4][5][6][7][8]. LSV has been linked to various infectious and non-infectious etiologies.…”