Fetal anemia, cerebellar hemorrhage and hypoplasia associated with congenital Parvovirus infection

Abstract

We report a case of fetal cerebellar hemorrhage and hypoplasia, identified by fetal MRI after intrauterine blood transfusion at 21 weeks' gestation for treatment of severe anemia due to congenital Parvovirus infection. Postnatal MRI confirmed atrophy of bilateral cerebellar hemispheres and inferior vermis. Cerebellar capillaries may be extremely susceptible to hemodynamic changes in the setting of intrauterine blood transfusion due to severe anemia. Although the correlation between fetal intracranial anomalies and Parvovirus infection remains unclear, in this population, a detailed evaluation of the brain parenchyma should be considered prior to and after intrauterine blood transfusion.

Fetal Brain Injury Associated with Parvovirus B19 Congenital Infection Requiring Intrauterine Transfusion

“…Finally, although the authors of two studies [11,12] speculated that hemodynamic change related to the severe anemia and subsequent IUT could have led to hemorrhagic reperfusion injury to the cerebellar germinal zones, our results did not find that a surge in hemoglobin level at the first IUT was associated with brain injury. However, the cerebellum is a rapidly growing, vulnerable brain structure with fragile developmental layers and vulnerable capillaries that can easily rupture, resulting in cerebellar hemorrhage.…”

“…In the literature, only isolated cases of fetal cerebellar hypoplasia or uni-or bilateral cerebellar hemorrhage have been reported in association with B19V infection. Sanapo et al [12] described 1 case with MR images at 34 WG showing bilateral hypoplasia of the cerebellar hemispheres (-2 SD), which was more pronounced inferiorly and associated with a vermis smaller than expected (height of the vermis -4 SD). Postnatal MRI confirmed atrophy of the cerebellar hemispheres and an inferior vermis.…”

“…Since the pathophysiological mechanisms of brain injury induced by fetal B19V infection remain unclear in the literature [9,11], our aim was to explore the hypotheses that have been previously suggested: (1) fetal cerebral injuries could be caused by ischemic stroke associated with severe anemia, similar to cases of severe fetal anemia associated with red blood cell alloimmunization [28][29][30]; (2) cerebral injuries could be linked to a direct effect of B19V [19]; and (3) cerebral injuries could be related to hemodynamic changes in cerebral blood flow when IUTs are performed, with sudden high increases in hemoglobin level [11,12].…”

“…However, the pathophysiological mechanisms of brain injury induced by fetal B19V infection remain unclear in the literature [9,11]. There are only few reports of isolated cases of prenatal neuroimaging findings related to congenital B19V infection [11][12][13][14].…”

Neuroimaging of Fetal Infection

“…1 Congenital malformations are uncommon in this infection, 1 although it may account for 4.6% of isolated mild ventriculomegaly. Polymicrogyria and heterotopia have been described 72,73 along with cerebellar hemorrhage and hypoplasia, 74 which may be due to thrombocytopenia.…”