Fetal intrakraniyal kanama: prenatal görüntüleme bulguları ve postnatal klinik sonuçlar

Öz

Amaç: Fetal intrakraniyal kanamanın görüntüleme bulgularını ve postnatal klinik özelliklerini araştırmak. Gereçler ve Yöntem: Çalışmaya kurumumuzda 2018-2020 yılları arasında ultrasonografi ve manyetik rezonans görüntüleme ile tanı konulan fetal intrakranial kanama olguları dahil edildi. Maternal özellikler, ultrason ve manyetik rezonans görüntüleme bulguları ile postnatal sonuçlar hasta kayıtlarından elde edildi. Bulgular: Tanı anında gestasyonel yaşı 21-35 hafta olan toplam 10 olgu tespit edildi. Sekiz fetusta intraventriküler kanama, bir fetusta serebellar kanama ve birinde hem intraventriküler hem de subdural kanama vardı. Olguların %60'ında tanımlanabilir bir risk faktörü saptandı. Ultrasonografi ile yedi fetusta intrakranial kanama tanısı konurken, üç fetusta diğer endikasyonlar için yapılan manyetik rezonans görüntüleme ile fetal intrakranial kanama saptandı. İki olguda gebelik sonlandırıldı, bir adet intrauterin fetal ölüm meydana geldi ve canlı doğan yedi olgu postnatal dönemde en az altı ay süreyle izlendi. Bunların %66,6'sında nörolojik bozukluk görüldü. Sonuç: Manyetik rezonans görüntüleme fetal intrakranial kanamanın tanı ve karakterizasyonunda önemli bir rol oynar ve ultrasonografiyi tamamlayıcıdır. Bu nedenle prenatal tanıda ultrason ve manyetik rezonans görüntüleme birlikte kullanılmalıdır.

Anahtar Kelimeler

• Fetal intrakraniyal kanama
• fetal manyetik rezonans görüntüleme
• intraventriküler kanama
• prenatal tanı
• ultrasonografi

Fetal intracranial hemorrhage: prenatal imaging findings and postnatal clinical outcome

Öz

Aim: To investigate imaging findings and postnatal clinical features of fetal intracranial hemorrhage. Materials and Method: Fetal intracranial hemorrhage cases detected in our institution between 2018 and 2020 by ultrasonography and magnetic resonance imaging were included. Maternal characteristics, ultrasonography and magnetic resonance imaging findings, and postnatal outcomes were noted. Results: A total of 10 cases with a gestational age of 21-35 weeks at the time of diagnosis were detected. Eight cases had an intraventricular hemorrhage, one case had a cerebellar hemorrhage, and one case had both intraventricular and subdural hemorrhage. An identifiable risk factor was detected in 60% of the cases. While intracranial hemorrhage was diagnosed by ultrasonography in seven cases, in 3 cases it was detected by magnetic resonance imaging that was performed for indications other than intracranial hemorrhage. In two cases pregnancy was terminated, one intrauterine fetal death occurred and seven cases born alive were followed up for at least six months in the postnatal period. Among these, the neurological disorder was observed in 66.6%. Conclusion: Fetal magnetic resonance imaging plays an important role in the diagnosis and characterization of intracranial hemorrhage and is complementary to ultrasonography. Hence we recommend using ultrasonography and magnetic resonance imaging together in its diagnosis.

Anahtar Kelimeler

• Fetal intracranial hemorrhage
• fetal magnetic resonance imaging
• intraventricular hemorrhage
• prenatal diagnosis
• ultrasonography

Kaynakça

1. 1 Vergani P, Strobelt N, Locatelli A, Paterlini G, Tagliabue P, Parravicini E, et al. Clinical significance of fetal intracranial hemorrhage. Am J Obstet Gynecol 1996;175:536–543 doi: 10.1053/ob.1996.v175.a73598. Cited in: PMID: 8928712
2. 2. Elchalal U, Yagel S, Gomori JM, Porat S, Beni-Adani L, Yanai N, et al. Fetal intracranial hemorrhage (fetal stroke): does grade matter? Ultrasound Obstet Gynecol 2005;26(3):233–243 doi: 10.1002/uog.1969. Cited in: PMID: 16082722
3. 3. Kutuk MS, Yikilmaz A, Ozgun MT, Dolanbay M, Canpolat M, Uludag S,et al. Prenatal diagnosis and postnatal outcome of fetal intracranial hemorrhage. Childs Nerv Syst 2014;30:411-418 doi: 10.1007/s00381-013-2243-0. Cited in: PMID: 23907139
4. 4. Kazanis I. The subependymal zone neurogenic niche: a beating heart in the centre of the brain: how plastic is adult neurogenesis? Opportunities for therapy and questions to be addressed. Brain 2009;132(11):2909–2921 doi: 10.1093/brain/awp237. Cited in: PMID: 19773354
5. 5. Sherer D, Anyaegbunam A, Onyeije C. Antepartum Fetal Intracranial Hemorrhage, Predisposing Factors and Prenatal Sonography: A Review. Am J Perinatol 1998; 15(07):431–441 doi: 10.1055/s-2007-993971. Cited in: PMID: 9759911
6. 6. Skovgaard A.L, Zachariassen G. Cranial ultrasound findings in preterm infants predict the development of cerebral palsy. Dan Med J 2017;64(2):A5330 Cited in: PMID: 28157062
7. 7. Perlman JM. Intrapartum hypoxic-ischemic cerebral injury and subsequent cerebral palsy: medicolegal issues. Pediatrics 1997;99(6):851-859 doi: 10.1542/peds.99.6.851. Cited in: PMID: 9164779
8. 8. International Society of Ultrasound in Obstetrics & Gynecology Education Committee. Sonographic examination of the fetal central nervous system: guidelines for performing the 'basic examination' and the 'fetal neurosonogram'. Ultrasound Obstet Gynecol 2007;29:109-116 doi: 10.1002/uog.3909. Cited in: PMID: 17200992

9. 9. 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;22:121-130 doi: 10.1002/uog.191. Cited in: PMID: 12905503
10. 10. Tan AP, Svrckova P, Cowan F, Chong WK, Mankad K. Intracranial hemorrhage in neonates: A review of etiologies, patterns and predicted clinical outcomes. Eur J Paediatr Neurol 2018;22(4):690-717 doi: 10.1016/j.ejpn.2018.04.008. Cited in: PMID: 29731328
11. 11. Scher MS, Belfar H, Martin J, Painter MJ. Destructive brain lesions of presumed fetal onset: antepartum causes of cerebral palsy. Pediatrics 1991;88:898–906 Cited in: PMID: 1945629
12. 12. 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;109:116–123 doi: 10.1542/peds.109.1.116. Cited in: PMID: 11773550
13. 13. Nelson KB, Lynch JK. Stroke in newborn infants. Lancet Neurol 2004;3:150–158 doi: 10.1016/S1474-4422(04)00679-9. Cited in: PMID: 14980530
14. 14. Sreenan C, Bhargava R, Robertson CM. Cerebral infarction in the term newborn: clinical presentation and long-term outcome. J Pediatr 2000;137:351–355 doi: 10.1067/mpd.2000.107845. Cited in: PMID: 10969259
15. 15. Ozduman K, Pober BR, Barnes P, Copel JA, Ogle EA, Duncan CC, et al. Fetal stroke. Pediatr Neurol 2004;30:151–162 doi: 10.1016/j.pediatrneurol.2003.08.004. Cited in: PMID: 15033196
16. 16. Minkoff H, Schaffer RM, Delke I, Grunebaum AN. Diagnosis of intracranial hemorrhage in utero after a maternal seizure. Obstet Gynecol 1985;65:22–24 Cited in: PMID: 3883270
17. 17. Sadler LC, Lane M, North R. Severe fetal intracranial haemorrhage during treatment with cholestyramine for intrahepatic cholestasis of pregnancy. Br J Obstet Gynaecol 1995;102:169–170 doi: 10.1111/j.1471-0528.1995.tb09077.x. Cited in: PMID: 7756215
18. 18. Strigini FA, Cioni G, Canapicchi R, Nardini V, Capriello P, Carmignani A. Fetal intracranial hemorrhage: is minor maternal trauma a possible pathogenetic factor? Ultrasound Obstet Gynecol 2001;18:335–342 doi: 10.1046/j.0960-7692.2001.00486.x Cited in: PMID: 11778992
19. 19. Hurst RW, Abbitt PL. Fetal intracranial hemorrhage and periventricular leukomalacia: complications of twin–twin transfusion. Am J Neuroradiol 1989;10:62–63 Cited in: PMID: 2505573
20. 20. Sherer DM, Abramowicz JS, Jaffe R, Smith SA, Metlay LA, Woods JR Jr. Twin–twin transfusion with abrupt onset of microcephaly in the surviving recipient following spontaneous death of the donor twin. Am J Obstet Gynecol 1993;169:85–88 doi: 10.1016/0002-9378(93)90136-7. Cited in: PMID: 8333482
21. 21. Barozzino T, Sgro M, Toi A, Akouri H, Wilson S, Yeo E, et al. Fetal bilateral subdural haemorrhages. Prenatal diagnosis and spontaneous resolution by time of delivery. Prenat Diagn 1998;18:496–503 Cited in: PMID: 9621385
22. 22. Kamphuis MM, Paridaans NP, Porcelijn L, Lopriore E, Oepkes D. Incidence and consequences of neonatal alloimmune thrombocytopenia: a systematic review. Pediatrics 2014;133(4):715-721 doi: 10.1542/peds.2013-3320. Cited in: PMID: 24590747
23. 23. Kovanlikaya A, Tiwari P, Bussel JB. Imaging and management of fetuses and neonates with alloimmune thrombocytopenia. Pediatr Blood Cancer 2017 doi: 10.1002/pbc.26690 Cited in: PMID: 28675682
24. 24. Abdelkader MA, Ramadan W, Gabr AA, Kamel A, Abdelrahman RW. Fetal intracranial hemorrhage: sonographic criteria and merits of prenatal diagnosis. J Matern Fetal Neonatal Med 2017;30(18):2250-2256 doi: 10.1080/14767058.2016.1245283. Cited in: PMID: 27718776
25. 25. Huang YF, Chen WC, Tseng JJ, Ho ES, Chou MM. Fetal intracranial hemorrhage (fetal stroke): report of four antenatally diagnosed cases and review of the literature. Taiwan J Obstet Gynecol 2006;45(2):135–141 doi: 10.1016/S1028-4559(09)60211-4. Cited in: PMID: 17197354
26. 26. Qi W, Luo JY, Li ZL, Zhang QJ, Liu ZD, Liao QP, et al. Clinical analysis of eight cases of fetal intracranial hemorrhage in pregnancy. J Matern Fetal Neonatal Med 2019;6:1-7 doi: 10.1080/14767058.2019.1670791. Cited in: PMID: 31588836 27. Adiego B, Martínez-Ten P, Bermejo C, Estévez M, Recio Rodriguez M, Illescas T. Fetal intracranial hemorrhage. Prenatal diagnosis and postnatal outcomes. J Matern Fetal Neonatal Med 2019;32(1):21-30 doi: 10.1080/14767058.2017.1369521. Cited in: PMID: 28826258
27. 28. Carletti A, Colleoni GG, Perolo A, Simonazzi G, Ghi T, Rizzo N, et al. Prenatal diagnosis of cerebral lesions acquired in utero and with a late appearance. Prenat Diagn 2009;29:389-395 doi: 10.1002/pd.2244. Cited in: PMID: 19333960
28. 29.Rossi AC, Prefumo F. Additional value of fetal magnetic resonance imaging in the prenatal diagnosis of central nervous system anomalies: a systematic review of the literature. Ultrasound Obstet Gynecol 2014;44:388–393 doi: 10.1002/uog.13429. Cited in: PMID: 24890732
29. 30. van Doorn M, Oude Rengerink K, Newsum EA, Reneman L, Majoie CB, Pajkrt E. Added value of fetal MRI in fetuses with suspected brain abnormalities on neurosonography: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2016;29(18):2949-2961 doi: 10.3109/14767058.2015.1109621. Cited in: PMID: 26592136
30. 31. Di Mascio D, Sileo FG, Khalil A, Rizzo G, Persico N, Brunelli R,et al. Role of magnetic resonance imaging in fetuses with mild or moderate ventriculomegaly in the era of fetal neurosonography: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2019;54(2):164-171 doi: 10.1002/uog.20197. Cited in: PMID: 30549340
31. 32. Sanapo L, Whitehead MT, Bulas DI, Ahmadzia HK, Pesacreta L, Chang T, et al. Fetal intracranial hemorrhage: role of fetal MRI. Prenat Diagn 2017;37(8):827-836 doi: 10.1002/pd.5096. Cited in: PMID: 28626857 33. Putbrese B, Kennedy A. Findings and differential diagnosis of fetal intracranial haemorrhage and fetal ischaemic brain injury: what is the role of fetal MRI? Br J Radiol 2017;90(1070):20160253 doi: 10.1259/bjr.20160253. Cited in: PMID: 27734711
32. 34. Kidwell CS, Wintermark M. Imaging of intracranial haemorrhage. Lancet Neurol 2008;7:256-267 doi: 10.1016/S1474-4422(08)70041-3. Cited in: PMID: 18275927
33. 35.Mukerji A, Shah V, Shah PS. Periventricular/Intraventricular Hemorrhage and Neurodevelopmental Outcomes: A Meta-analysis. Pediatrics 2015;136(6):1132-1143 doi: 10.1542/peds.2015-0944. Cited in: PMID: 26598455