Neurologic Outcome in Neonatal Temporal Lobe Hemorrhagic Venous Infarcts

Slaughter, Laurel A.; Egelhoff, John C.; Balmakund, Tonya

doi:10.1177/0883073809333529

Cited by 10 publications

(3 citation statements)

References 8 publications

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“…In our group, 11 infants had involvement of the temporal lobe, and 6/11 (54.5%) presented with apneic seizures (Fig. 4) Slaughter et al [13] described the surprisingly good outcome of infants with hemorrhagic infarct in the temporal lobe. As there was only one infant with a single temporal hemorrhage in our population, we cannot draw the same conclusion.…”

Section: Discussionsupporting

confidence: 49%

Intracranial hemorrhage in full-term newborns: a hospital-based cohort study

et al. 2010

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IntroductionIn recent years, intracranial hemorrhage (ICH) with parenchymal involvement has been diagnosed more often in full-term neonates due to improved neuroimaging techniques. The aim of this study is to describe clinical and neuroimaging data in the neonatal period and relate imaging findings to outcome in a hospital-based population admitted to a level 3 neonatal intensive care unit (NICU).MethodsFrom our neuroimaging database, we retrospectively retrieved records and images of 53 term infants (1991–2008) in whom an imaging diagnosis of ICH with parenchymal involvement was made. Clinical data, including mode of delivery, clinical manifestations, neurological symptoms, extent and site of hemorrhage, neurosurgical intervention, and neurodevelopmental outcomes, were recorded.ResultsSeventeen of the 53 term infants had infratentorial ICH, 20 had supratentorial ICH, and 16 had a combination of the two. Seizures were the most common presenting symptom (71.7%), another ten infants (18.9%) presented with apneic seizures, and five infants had no clinical signs but were admitted to our NICU because of perinatal asphyxia (n = 2), respiratory distress (n = 2), and development of posthemorrhagic ventricular dilatation (n = 1). Continuous amplitude-integrated electroencephalography recordings were performed in all infants. Clinical or subclinical seizures were seen in 48/53 (90.6%) infants; all received anti-epileptic drugs. Thirteen of all 53 (24.5%) infants died. The lowest mortality rate was seen in infants with supratentorial ICH (10%). Three infants with a midline shift required craniotomy, six infants needed a subcutaneous reservoir due to outflow obstruction, and three subsequently required a ventriculoperitoneal shunt. The group with poor outcome (death or developmental quotient (DQ) <85) had a significantly lower 5-min Apgar score (p = .006). Follow-up data were available for 37/40 survivors aged at least 15 months. Patients were assessed with the Griffiths Mental Developmental Scales, and the mean DQ of all survivors was 97 (SD = 12). Six infants (17%) had a DQ below 85 [two of them had cerebral palsy (CP)]. Three infants developed CP (8.6%); one had cerebellar ataxia, and two had hemiplegia.ConclusionICH with parenchymal involvement carries a risk of adverse neurological sequelae with a mortality of 24.5% and development of CP in 8.6%. The high mortality rate could partly be explained by associated perinatal asphyxia. Infants with supratentorial ICH had a lower, although not significant, mortality rate compared with infants with infratentorial ICH and infants with a combination of supratentorial ICH and infratentorial ICH. In spite of often large intraparenchymal lesions, 30 of the 34 survivors without CP (88.2%) had normal neurodevelopmental outcome at 15 months.

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Section: Discussionsupporting

confidence: 49%

Intracranial hemorrhage in full-term newborns: a hospital-based cohort study

et al. 2010

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“…Moreover, previous studies also proved that the resection or thrombosis of VOL in epilepsy surgery might not be related to subsequent infarction or poor outcome. 22, 23 Meanwhile, the drainage of VOT can be compensated by abundant superior anastomotic veins, which initiate the recruitment of venous collateral pathways.…”

Section: Discussionmentioning

confidence: 99%

Absent Filling of Ipsilateral Superficial Middle Cerebral Vein Is Associated With Poor Outcome After Reperfusion Therapy

Zhang

Lai

Ding

et al. 2017

Stroke

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Background and purpose Our aim was to study the effect of drainage of cortical veins, including the superficial middle cerebral vein (SMCV), vein of Trolard (VOT), and vein of Labbé (VOL) on neurological outcomes after reperfusion therapy. Methods Consecutive ischemic stroke patients who underwent pretreatment CT perfusion (CTP) and 24-hour CTP or MR perfusion after intravenous thrombolysis were included. We defined “absent filling of ipsilateral cortical vein” (e.g. SMCV-) as no contrast filling of the vein across the whole venous phase on four-dimensional CT angiography in the ischemic hemisphere. Results Of 228 patients, SMCV-, VOT- and VOL- were observed in 50 (21.9%), 27 (11.8%), and 32 (14.0%) patients, respectively. Only SMCV- independently predicted poor outcome (3-month modified Rankin Scale score>2) (OR=2.710, p=0.040). No difference was found in reperfusion rate after treatment between patients with and without SMCV- (p>0.05). In patients achieving major reperfusion (≥80%), there was no difference in 24-hour infarct volume, or rate of poor outcome between patients with and without SMCV- (p>0.05). However, in those without major reperfusion, patients with SMCV- had larger 24-hour infarct volume (p=0.011), higher rate of poor outcome (p=0.012), and death (p=0.032), compared to those with SMCV filling. SMCV- was significantly associated with brain edema at 24 hours (p=0.037) which, in turn, was associated with poor 3-month outcome (p=0.002). Conclusions Lack of SMCV filling contributed to poor outcome after thrombolysis, especially when reperfusion was not achieved. The main deleterious effect of poor venous filling appears related to the development of brain edema.

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“…6–7,13 In a report of 7 newborns with unilateral temporal lobe infarcts secondary to superficial cortical venous thrombosis, all but one had normal development and neurologic exams at latest follow-up (ranging from 10 months to 5 years). In contrast, half of the infants and children with CSVT had evidence of neurodevelopmental impairment at latest follow-up (mean interval from thrombosis to last follow-up visit 1.6 years) with 80% of neurologic deficits being motor.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Vein of Labbé Infarction Size is Associated With Long-Term Language Outcomes

Benninger

Ruess

Slaughter

et al. 2017

Pediatric Neurology

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BACKGROUND The vein of Labbé (VOL) is a superficial cortical vein which drains the lateral surface of the temporal lobe. Thrombosis of the VOL can occur in the neonatal period. The developmental outcomes of infants who had VOL thrombosis are unknown as few studies of outcomes exist. METHODS Retrospective chart review of infants born ≥34 weeks gestation, diagnosed with VOL thrombosis and/or infarction on neuroimaging during the first 30 days of life. Size of each temporal lobe infarction was estimated based on number of temporal lobe’s segments involved. Primary outcomes were presence of major neurodevelopmental impairments in childhood and Bayley scores at 2 years. RESULTS Our cohort of 19 infants had a median gestational age of 38 weeks [IQR 36–39] and mean birthweight 2892±920 grams. The most common presenting symptoms of VOL thrombosis and infarction of surrounding tissue were seizures, apnea, lethargy and either hyper- or hypotonia. At the latest clinical follow-up appointment documented in the electronic medical record (mean 4.4±3.08 years), 44% had major neurodevelopmental impairment. Patients with large VOL infarctions had significantly worse average Bayley scores than those with small to moderate lesions, differences in language composite were statistically significant (72.7 vs 107.8, p = 0.017). CONCLUSIONS Neonates with large VOL infarctions are more likely to have poor language outcomes. This suggests a need for targeted surveillance to ensure early identification of deficits and referral for intervention.

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Neurologic Outcome in Neonatal Temporal Lobe Hemorrhagic Venous Infarcts

Cited by 10 publications

References 8 publications

Intracranial hemorrhage in full-term newborns: a hospital-based cohort study

Intracranial hemorrhage in full-term newborns: a hospital-based cohort study

Absent Filling of Ipsilateral Superficial Middle Cerebral Vein Is Associated With Poor Outcome After Reperfusion Therapy

Neonatal Vein of Labbé Infarction Size is Associated With Long-Term Language Outcomes

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