Öz
Aim: In this study our aim is to determine the value of prenatal MRI in the diagnosis of fetal stroke and its etiology. Patients and Methods: Two hundred twenty two fetal MRI’s which were referred to our center between 2006-2009 were retrospectively studied. Of these cases, 8 patients fulfilled the criteria of diagnosis of fetal stroke mean gestational age 25.6 weeks range 20-33 weeks . The patients were examined in a 1.5T MR scanner with “receive only” body coil without maternal sedation. The images were obtained by T2 weighted HASTE, FLASH 2D TSE, and diffusion weighted sequences. Results: Fetal stroke was diagnosed in 8 fetuses 3.6% . Out of 8 fetuses, 6 had 75% intraventricular and/or germinal matrix hemorrhage. One fetus had infarct after co-twin death and developed parietal lobe encephalomalacia, and one patient had a dural sinus aneurysm with central T2 hypointensity in posterior fossa located at torcular herophili a associated with hemorrhage. Four of these fetuses were terminated during pregnancy. Conclusion: Prenatal MRI is useful in the diagnosis of stroke and identification of the etiology in fetuses. Recognition of these abnormalities in early fetal life may result in termination of pregnancy or to undertake close follow-up of neurological status of those who are born alive.
Kaynakça
- Trauner DA, Nass R, Ballantyne A. Behavioural profiles of children and adolescents after pre- or perinatal unilateral brain damage. Brain. 2001 May;124(Pt 5):995-1002.
- Lynch JK, Hirtz DG, DeVeber G, Nelson KB. Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke. Pediatrics. 2002 Jan;109(1):116-23.
- Lynch JK. Epidemiology and classification of perinatal stroke. Semin Fetal Neonatal Med. 2009 Oct;14(5):245-9.
- Ozduman K, Pober BR, Barnes P, Copel JA, Ogle EA, Duncan CC, et al. Fetal stroke. Pediatr Neurol. 2004 Mar;30(3):151-62.
- Ghi T, Simonazzi G, Perolo A, Savelli L, Sandri F, Bernardi B, et al. Outcome of antenatally diagnosed intracranial hemorrhage: case series and review of the literature. Ultrasound Obstet Gynecol. 2003 Aug;22(2):121-30.
- Özduman K DVG, Ment LR. Stroke in the fetus and neonate. In: Perlman, editor. Neurology, Neonatology Questions and Controversies: Saunders; 2008. p. 88-120.
- Perlman JM, Rollins NK, Evans D. Neonatal stroke: clinical characteristics and cerebral blood flow velocity measurements. Pediatr Neurol. 1994 Nov;11(4):281-4.
- Uvebrant P. Hemiplegic cerebral palsy. Aetiology and outcome. Acta Paediatr Scand Suppl. 1988;345:1-100.
- Catanzarite VA, Schrimmer DB, Maida C, Mendoza A. Prenatal sonographic diagnosis of intracranial haemorrhage: report of a case with a sinusoidal fetal heart rate tracing, and review of the literature. Prenat Diagn. 1995 Mar;15(3):229-35.
- Groothuis AM, de Kleine MJ, Oei SG. Intraventricular haemorrhage in utero. A case-report and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2000 Apr;89(2):207-11.
- Levine D. Ultrasound versus magnetic resonance imaging in fetal evaluation. Top Magn Reson Imaging. 2001 Feb;12(1):25-38.
- Levine D. Fetal magnetic resonance imaging. Top Magn Reson Imaging. 2001 Feb;12(1):1-2.
- Mercuri E, Rutherford M, Cowan F, Pennock J, Counsell S, Papadimitriou M, et al. Early prognostic indicators of outcome in infants with neonatal cerebral infarction: a clinical, electroencephalogram, and magnetic resonance imaging study. Pediatrics. 1999 Jan;103(1):39-46.
- Merzoug V, Flunker S, Drissi C, Eurin D, Grange G, Garel C, et al. Dural sinus malformation (DSM) in fetuses. Diagnostic value of prenatal MRI and follow-up. Eur Radiol. 2008 Apr;18(4):692-9.
- Levine D. Case 46: encephalomalacia in surviving twin after death of monochorionic co-twin. Radiology. 2002 May;223(2):392-5.
- Pistorius LR, Hellmann PM, Visser GH, Malinger G, Prayer D. Fetal neuroimaging: ultrasound, MRI, or both? Obstet Gynecol Surv. 2008 Nov;63(11):733-45.
- Kirton A, deVeber G. Advances in perinatal ischemic stroke. Pediatr Neurol. 2009 Mar;40(3):205-14.
Öz
Amaç: Bu çalışmada amacımız fetal inme tanısında ve etyolojisinin saptanmasında prenatal MR görüntülemenin katkısını değerlendirmektedir. Hastalar ve Yöntem: 2006 Ocak-2009 Aralık tarihleri arasında bölümümüzde yapılan 222 prenatal MRI olgusunun retrospektif olarak incelenmesinde fetal inme kriterlerine uyan toplam 8 olgu ortalama gestasyonel yaş 25.6 hafta 20-33 hafta saptanmıştır. Olgular 1.5T MR cihazında “receive only” vücut sarmalı ile annelere sedasyon uygulanmadan incelenmiştir. Görüntüler T2 ağırlıklı HASTE, FLASH 2D T1 ağırlıklı ve diffüzyon ağırlıklı sekanslarla elde edilmiştir. Bulgular: Toplam 8 fetusta %3.6 inme saptanmıştır. Bunların 6’sında %75 intraventriküler ve/veya germinal matriks kanaması saptanmıştır. Bir fetusta ikiz eşi ölümüne bağlı parietal lob yerleşimli kistik ensefalomalazi sahası gözlenmiştir, bir fetusta ise posterior fossada torkular herofili yerleşimli, tentorium ve vermisi iten, T2’de santrali hipointens dural sinus anevrizması ve eşlik eden hematoma bulgusu saptanmıştır. Bu gebeliklerden dördü sonlandırılmıştır. Sonuç: Prenatal MR görüntüleme fetal inme tanısı etyolojisini saptamak için önemlidir. Fetal dönemde erken tanınması terminasyon kararı veya doğurtulan hastalarda yakın nörolojik takip olasılığı sağlamaktadır.
Anahtar Kelimeler
Kaynakça
- Trauner DA, Nass R, Ballantyne A. Behavioural profiles of children and adolescents after pre- or perinatal unilateral brain damage. Brain. 2001 May;124(Pt 5):995-1002.
- Lynch JK, Hirtz DG, DeVeber G, Nelson KB. Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke. Pediatrics. 2002 Jan;109(1):116-23.
- Lynch JK. Epidemiology and classification of perinatal stroke. Semin Fetal Neonatal Med. 2009 Oct;14(5):245-9.
- Ozduman K, Pober BR, Barnes P, Copel JA, Ogle EA, Duncan CC, et al. Fetal stroke. Pediatr Neurol. 2004 Mar;30(3):151-62.
- Ghi T, Simonazzi G, Perolo A, Savelli L, Sandri F, Bernardi B, et al. Outcome of antenatally diagnosed intracranial hemorrhage: case series and review of the literature. Ultrasound Obstet Gynecol. 2003 Aug;22(2):121-30.
- Özduman K DVG, Ment LR. Stroke in the fetus and neonate. In: Perlman, editor. Neurology, Neonatology Questions and Controversies: Saunders; 2008. p. 88-120.
- Perlman JM, Rollins NK, Evans D. Neonatal stroke: clinical characteristics and cerebral blood flow velocity measurements. Pediatr Neurol. 1994 Nov;11(4):281-4.
- Uvebrant P. Hemiplegic cerebral palsy. Aetiology and outcome. Acta Paediatr Scand Suppl. 1988;345:1-100.
- Catanzarite VA, Schrimmer DB, Maida C, Mendoza A. Prenatal sonographic diagnosis of intracranial haemorrhage: report of a case with a sinusoidal fetal heart rate tracing, and review of the literature. Prenat Diagn. 1995 Mar;15(3):229-35.
- Groothuis AM, de Kleine MJ, Oei SG. Intraventricular haemorrhage in utero. A case-report and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2000 Apr;89(2):207-11.
- Levine D. Ultrasound versus magnetic resonance imaging in fetal evaluation. Top Magn Reson Imaging. 2001 Feb;12(1):25-38.
- Levine D. Fetal magnetic resonance imaging. Top Magn Reson Imaging. 2001 Feb;12(1):1-2.
- Mercuri E, Rutherford M, Cowan F, Pennock J, Counsell S, Papadimitriou M, et al. Early prognostic indicators of outcome in infants with neonatal cerebral infarction: a clinical, electroencephalogram, and magnetic resonance imaging study. Pediatrics. 1999 Jan;103(1):39-46.
- Merzoug V, Flunker S, Drissi C, Eurin D, Grange G, Garel C, et al. Dural sinus malformation (DSM) in fetuses. Diagnostic value of prenatal MRI and follow-up. Eur Radiol. 2008 Apr;18(4):692-9.
- Levine D. Case 46: encephalomalacia in surviving twin after death of monochorionic co-twin. Radiology. 2002 May;223(2):392-5.
- Pistorius LR, Hellmann PM, Visser GH, Malinger G, Prayer D. Fetal neuroimaging: ultrasound, MRI, or both? Obstet Gynecol Surv. 2008 Nov;63(11):733-45.
- Kirton A, deVeber G. Advances in perinatal ischemic stroke. Pediatr Neurol. 2009 Mar;40(3):205-14.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2010 |
| Yayımlandığı Sayı | Yıl 2010Sayı: 2 |