Screening for Brain Involvement in Infants with Multifocal Cutaneous Infantile Hemangiomas

Abstract

Background: Multifocal (≥5) infantile hemangiomas (IHs) are known as a risk factor for extracutaneous involvement. Liver is the most commonly involved organ, but involvement of other systems has also been reported. This study aims to describe the characteristic findings in a group of infants with multiple cutaneous hemangiomas, with emphasis on intracranial involvement. Methods: A retrospective case series study was carried out in a pediatric dermatology unit of a tertiary pediatric medical center. Patients diagnosed with multiple cutaneous IHs from 2006 to 2015 were identified by a computerized search. Clinical data were retrieved from the medical charts. Results: A total of 60 infants (37 females and 23 males) were identified for analysis. Forty-four brain ultrasounds were recorded and reported as normal. One patient out of the 44 was later diagnosed with a small asymptomatic hemangioma seen on a brain MRI/MRA done for another indication. Conclusion: Brain hemangiomas may present as an asymptomatic incidental finding in infants presenting with multifocal cutaneous and liver IHs. The single case reported in our study emphasizes the low prevalence and the benign course expected. Therefore, routine ultrasound screening for brain involvement is probably unnecessary for this population.

Diffuse neonatal hemangiomatosis with a single atypical cutaneous hemangioma

“…Ten is the least number of lesions on the skin from the total of 16 cases of cutaneous hemangioma with brain involvement reported by Friedland et al. [3] . More than half (9 of 16 cases) of the infants in their study experienced neurological symptoms related to brain hemangioma and 6 cases died.…”

Safe and Effective Treatment of Intracranial Infantile Hemangiomas with Beta-Blockers

“…We identified 41 cases of reported intracranial infantile hemangioma in the literature ( Table 1 ) [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. The majority of patients were female (68%).…”

“…Due to their rarity, there is currently no consensus on the optimal, evidence-based treatment of intracranial infantile hemangiomas. We found that some small asymptomatic lesions were managed with observation alone [ 13 , 20 , 21 , 23 , 31 ], and the hemangiomas spontaneously regressed in some cases [ 23 , 31 ]. Ten patients underwent surgical treatment [ 9 , 12 , 14 , 17 , 19 , 22 , 24 , 26 , 27 , 30 ].…”

“…This report was reviewed by the Oxford University Hospitals’ ethics team and formal ethical approval was deemed not to be required. We performed a literature review using Pubmed, searching for keywords “intracranial infantile hemangioma/s”, and identified 41 reported cases ( Table 1 ) [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. There was no uniform treatment approach observed.…”

Multifocal cutaneous infantile haemangiomata: A multisystem disorder with persistent hypopituitarism

“…Although historical case reports suggest brain involvement in up to 50% of cases, a more recent retrospective review of 60 infants with multifocal IH showed brain involvement found in just 1 infant. 7 This large variation in reported rates of intracranial involvement may be due to the inconsistent terminology used in older reports of infantile vascular lesions prior to the development of The International Society for the Study of Vascular Anomalies model in 1996. 8 On this basis, routine neuroimaging is not recommended in infants with multifocal IHs.…”