Deep Medullary Vein White Matter Injury Global Severity Score Predicts Neurodevelopmental Impairment

Abstract

Aim: To examine associations between the deep medullary vein white matter injury global severity scoring system and neurodevelopmental impairment. Methods: This is a prospective observational cohort study of infants born at ≥32 weeks, diagnosed with deep medullary vein thrombosis and infarction on neuroimaging in the first month of life. Developmental testing was performed using validated measures for early, preschool, and school-age follow-up. Results: Nineteen (37%) patients had major neurodevelopmental impairment. Global severity score was higher among patients with neurodevelopmental impairment (21.6 vs 13.4, P = .04). Overall, 78% of patients with epilepsy had neurodevelopmental impairment. A greater degree of asymmetry with right-sided injury predominance was associated with lower Bayley-III cognitive scores and presence of neurodevelopmental impairment ( P < .01). Conclusions: Results suggest a need for targeted clinical surveillance for patients with a high global severity score and/or asymmetric, predominantly right cerebral white matter injury and for those who develop epilepsy.

Perinatal arterial ischemic stroke and periventricular venous infarction in infants with unilateral cerebral palsy

“…Another plausible explanation for chorioamnionitis increasing the odds of PVI is the possibility that a subset of these PVI cases were infants who sustained their injury in the peripartum period due to cerebral sinus vein thrombosis of the medullary veins, for which chorioamnionitis is a risk factor 32 . There is increasing evidence to suggest that the initial detection of such strokes is under‐recognized and later falsely classified as fetal PVI 33 . Future risk factor studies highlighting unique profiles associated with fetal PVI versus neonatal cerebral sinus vein thrombosis are necessary to shed further light on such misdiagnoses.…”

“…32 There is increasing evidence to suggest that the initial detection of such strokes is under-recognized and later falsely classified as fetal PVI. 33 Future risk factor studies highlighting unique profiles associated with fetal PVI versus neonatal cerebral sinus vein thrombosis are necessary to shed further light on such misdiagnoses.…”

Neuroimaging in Perinatal Stroke and Cerebrovascular Disease

“…The thrombosed vein may be seen overlying the infarction as a curvilinear region of high attenuation, depending upon the age of the thrombus. Infarctions occur in the territory of thrombosed venous, with parasagittal injuries in superior sagittal sinus thrombosis, temporal lobe hematomas in transverse sinus thrombosis, and thalamic hemorrhage in vein of Galen and straight sinus thromboses (99).…”

A radiomics-based study of deep medullary veins in infants: Evaluation of neonatal brain injury with hypoxic-ischemic encephalopathy via susceptibility-weighted imaging

“…Cerebral hypoxia and ischemia can lead to cerebral venous congestion and increased venous pressure, which in turn, can easily cause the deep cerebral and cortical veins to expand to varying degrees ( Mukherjee et al, 2021 ). Neonates with hypoxic-ischemic brain injury and HIE have recently been reported to have abnormal, prominent veins ( Messina et al, 2013 ), and there is a close relationship between the deep medullary veins (DMV) and WM injury in neonates ( Arrigoni et al, 2011 ; Chen et al, 2020 ; Khalatbari et al, 2020 ; Benninger et al, 2021 ). In some infants, the veins are indeed prominent.…”