Venous subtypes of preterm periventricular haemorrhagic infarction

Abstract

Background:Periventricular haemorrhagic infarction (PVHI) is a complication of preterm birth that may lead to impairment and disability. Early diagnosis is possible by cranial ultrasonography (CUS). Extensive PVHI lesions can be graded using a scoring system that relates to outcome, based on CUS characteristics. Data on more subtle unilateral forms of PVHI are lacking.

Objective:To refine PVHI classification by relating subtypes to affected veins and evaluate effects of these different anatomical subtypes on neurological outcome.

Methods:We retrospectively analyzed images and neurological outcome of 20 preterm infants with unilateral PVHI. Based on affected veins we classified PVHI into six subtypes. Sonographic templates of infarct types are provided in coronal and parasagittal plane. Standardized neurological examinations were done (according to Amiel-Tison and Touwen's examinations) and children were classified as: normal, mildly or definitely abnormal. The outcome was based on the most recent neurological examination, at a corrected age of 1 (n=7), 2 (n=5), 3 (n=5) or 5 (n=3) years of age.

Results:PVHI classification of the 20 patients was as follows: temporal (n=3), pure caudate (n=3), anterior terminal (n=6), complete terminal (n=3), extensive (n=4), other (n=1). With one exception, only PVHI patients showing the latter three subtypes had developed severe spastic contralesional hemiplegia.

Conclusions:The classification developed for PVHI correlates with neurological outcome. This refinement can help clinicians in predicting neurological outcome at an early stage, with a subsequent targeted rehabilitation schedule already early in life.