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

Abstract

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.

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

“…Individuals with large venous infarctions are more likely to experience neurodevelopmental impairment. 46 Fitzgerald et al 48 summarized 42 neonates with CSVT, and detailed follow-up data were available for 27 of the 41 survivors. Sixteen of these 27 (59%) had cognitive impairment; 18 (67%) had cerebral palsy; and 11 (41%) had epilepsy.…”

Deep Medullary Vein Thrombosis in Newborns: A Systematic Literature Review

“…Patients with severe neurodevelopmental impairment had a higher grade of severity of brain damage compared to patients with little or no impairment, whereas gestational age, birth weight, socioeconomic status were not different between the two groups [4]. Similarly, in neonates with CSVT, outcomes appear to be related to the extent and the bilateral localization of the infarction associated with thrombosis [6, 39, 47, 48]. Given the high rate of morbidity, social and health costs related to DMV thrombosis appear to be significant.…”