The Cerebellar-Cerebral Microstructure Is Disrupted at Multiple Sites in Very Preterm Infants with Cerebellar Haemorrhage

Neubauer, Vera; Djurdjevic, Tanja; Griesmaier, Elke; Biermayr, Marlene; Gizewski, Elke R.; Kiechl‐Kohlendorfer, Ursula

doi:10.1159/000480695

Cited by 7 publications

(6 citation statements)

References 23 publications

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“…Furthermore, in agreement with microstructural diffusion tensor imaging research that demonstrated the association between isolated preterm CbH and widespread bilateral cerebello-cerebral circuit alterations 48 , we showed that isolated preterm CbH is linked to widespread cortical gray matter alteration patterns that include bidirectional changes in cortical thickness and cortical surface area. There are several, not mutually exclusive, explanations for the exposed patterns 49,50 .…”

Section: Discussionsupporting

confidence: 89%

“…For instance, homologous regions of the ipsilateral hemisphere might be included in a broader neuronal network that indirectly, for instance via the corpus callosum, suffers from the functional disconnection of the cerebellum 46 . This hypothesis lends support from studies that suggest that the injury is not confined to the site where it initially occurred and that it may result in experience-dependent structural remodeling of the entire cerebello-cerebral circuit 48,52,64 . In line with this view, the differences found between case-cohort groups might as well reflect data that are consistent with the more contemporary network-based view of the neural correlates for cognitive dysfunction.…”

Section: Cortical Cluster Cbh#3 Cg#3mentioning

confidence: 53%

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Preterm infants with isolated cerebellar hemorrhage show bilateral cortical alterations at term equivalent age

Dijkshoorn

Turk

Hortensius

et al. 2020

Sci Rep

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the cerebellum is connected to numerous regions of the contralateral side of the cerebrum. Motor and cognitive deficits following neonatal cerebellar hemorrhages (CbH) in extremely preterm neonates may be related to remote cortical alterations, following disrupted cerebello-cerebral connectivity as was previously shown within six CbH infants. In this retrospective case series study, we used MRI and advanced surface-based analyses to reconstruct gray matter (GM) changes in cortical thickness and cortical surface area in extremely preterm neonates (median age = 26; range: 24.9-26.7 gestational weeks) with large isolated unilateral CbH (N = 5 patients). Each CbH infant was matched with their own preterm infant cohort (range: 20-36 infants) based on sex and gestational age at birth. On a macro level, our data revealed that the contralateral cerebral hemisphere of CbH neonates did not show less cortical thickness or cortical surface area than their ipsilateral cerebral hemisphere at term. None of the cases differed from their matched cohort groups in average cortical thickness or average cortical surface area in the ipsilateral or contralateral cerebral hemisphere. On a micro (i.e. vertex) level, we established high variability in significant local cortical GM alteration patterns across case-cohort groups, in which the cases showed thicker or bigger volume in some regions, among which the caudal middle frontal gyrus, insula and parahippocampal gyrus, and thinner or less volume in other regions, among which the cuneus, precuneus and supratentorial gyrus. This study highlights that cerebellar injury during postnatal stages may have widespread bilateral influence on the early maturation of cerebral cortical regions, which implicate complex cerebello-cerebral interactions to be present at term birth. The cerebellum is fundamental for cognitive and coordinated motor function, varying from sensorimotor mapping to language regulation (as reviewed by Caligiore et al.) 1. Pioneering work in both animal and human studies has established that the cerebellum collaborates with the cerebral cortex and sends output to, and receives input from, contralateral cortical areas via enclosed-loops 2-5 , In human these projection areas include multiple higher-order cerebral regions, such as the dorsolateral prefrontal cortex, the parietal and superior temporal lobes 6-8. Cerebello-cerebral loops are thought to be anatomically separated and involved in distinct functional processes 1,9. Many of these efferent and afferent connections have been identified as early as term-equivalent age (TEA) in preterm infants 10-12. Cerebellar hemorrhage (CbH) is a common neonatal complication with an ultrasound-detected incidence of 7.6% in extremely preterm infants (gestational age at birth <28 weeks) 13. In general the most immature and the sickest children are at a higher risk for developing CbH 14,15 , The actual incidence, however, may be higher as it has likely been underdiagnosed clinically. A recent review demonstrates that between 43% and 75% of t...

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Section: Discussionsupporting

confidence: 89%

Section: Cortical Cluster Cbh#3 Cg#3mentioning

confidence: 53%

Preterm infants with isolated cerebellar hemorrhage show bilateral cortical alterations at term equivalent age

Dijkshoorn

Turk

Hortensius

et al. 2020

Sci Rep

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“…Region of interest for the pons was chosen at the level of the middle cerebellar peduncles with a central circle of 2 mm 2 area. Regions were manually positioned on the FA map and copied to the ADC map as described in a previous study [15].…”

Section: Methodsmentioning

confidence: 99%

Microstructural Brain Development and Neurodevelopmental Outcome of Very Preterm Infants of Mothers with Gestational Diabetes Mellitus

Sappler,

Volleritsch,

Hammerl

et al. 2023

Neonatology

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Introduction: There are data linking gestational diabetes mellitus (GDM) with adverse neurodevelopmental outcome in the offspring. We investigated the effect of GDM on microstructural brain development and neurodevelopmental outcome of very preterm infants. Materials and Methods: Preterm infants <32 gestational weeks of mothers with GDM obtained cerebral magnetic resonance imaging (MRI) including diffusion-tensor imaging at term-equivalent age. For every infant, two gestational age-, sex-, and MRI scanner type-matched controls were included. Brain injury was assessed and fractional anisotropy (FA) and apparent diffusion coefficient (ADC) measured in 14 defined cerebral regions. Neurodevelopmental outcome was quantified at the corrected age of 24 months using the Bayley Scales of Infant Development. Results: We included 47 infants of mothers with GDM and 94 controls. There were no differences in neonatal morbidity between the groups, nor in any type of brain injury. The GDM group showed significantly higher FA values in the centrum semiovale, the posterior limb of the internal capsule and the pons bilaterally, in the corpus callosum and the right occipital white matter, as well as lower ADC values in the right centrum semiovale, the right occipital white matter and the corpus callosum. Neurodevelopmental outcome did not differ between the groups. Conclusion: We found no impairment of brain development in GDM-exposed infants compared to matched controls, but differences in white matter microstructure in specific regions indicating an enhanced maturation. However, neurodevelopmental outcome was equal in both groups. Further studies are needed to better understand brain maturation in preterm infants exposed to GDM.

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“…FA and ADC values were measured bilaterally in the centrum semiovale, in the posterior limb of the internal capsule, and in the genu and splenium of the corpus callosum [10]. Regions were manually positioned on the FA map and copied to the ADC map [11]. To validate our data, 20 infants selected at random were analyzed by two independent observers.…”

Section: Methodsmentioning

confidence: 99%

Relationship between Brain Function and Microstructural Brain Maturation in Preterm Infants

Winkler,

Sappler,

Gizewski

et al. 2023

Neonatology

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Introduction: Preterm infants are at risk for impairment in brain maturation at term equivalent age (TEA). Diffusion tensor imaging (DTI) is a powerful magnetic resonance imaging (MRI) technique, quantitatively reflecting microstructural brain development of white matter regions with parameters such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Amplitude-integrated electroencephalography (aEEG) assesses electrocortical activity and brain function. Methods: Aim of this study was to investigate a possible correlation between functional and microstructural brain maturation using neonatal aEEG and DTI-MRI at TEA. The study was conducted as a retrospective single-center study in 446 infants born below 32 gestational weeks. Spearman rank’s correlation coefficients were calculated between aEEG (total maturation score) and FA/ADC value. To compare aEEG and DTI-MRI to neurodevelopmental outcome at 24 months of corrected age, we performed a multivariate linear regression analysis. Results: Analysis showed an all-time significant correlation between total maturation score and FA/ADC values of the corpus callosum at TEA with the strongest correlation at day 2, day 3, week 3, and week 4. After including perinatal variables in the model, this correlation remained highly significant at day 2 and 3. When comparing the association of aEEG and DTI-MRI to outcome, both the total maturation score at day 2, day 3, and FA/ADC of the splenium of the corpus callosum showed a significant correlation. Conclusion: This study indicates that early monitoring of functional brain maturation may predict later assessment of microstructural brain development of corpus callosum in preterm infants with a relation to neurodevelopmental outcome.

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The Cerebellar-Cerebral Microstructure Is Disrupted at Multiple Sites in Very Preterm Infants with Cerebellar Haemorrhage

Cited by 7 publications

References 23 publications

Preterm infants with isolated cerebellar hemorrhage show bilateral cortical alterations at term equivalent age

Preterm infants with isolated cerebellar hemorrhage show bilateral cortical alterations at term equivalent age

Microstructural Brain Development and Neurodevelopmental Outcome of Very Preterm Infants of Mothers with Gestational Diabetes Mellitus

Relationship between Brain Function and Microstructural Brain Maturation in Preterm Infants

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