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Cerebellar infarction: an unrecognized complication of very low birthweight
Stanley D Johnsen1, Theodore J Tarby, Kara Stuart Lewis
1Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston 77030, USA. sdjohnse@texaschildrenshospital.org
Insights
Extremely premature infants (gestational age 24-27 weeks) with low birthweights often experience severe cerebellar injury. This underappreciated condition is linked to cerebral palsy, microcephaly, and visual impairments.
Area of Science:
- Neurology
- Pediatrics
- Neonatology
Background:
- Cerebral palsy affects children with extremely low birthweights.
- Cerebellar injury is a potential complication in premature infants.
Purpose of the Study:
- To investigate the prevalence and characteristics of cerebellar injury in extremely premature infants with cerebral palsy.
- To correlate MRI findings with clinical outcomes.
Main Methods:
- Retrospective review of neonatal records for 13 children with cerebral palsy and birthweights under 1085g.
- Magnetic resonance imaging (MRI) of the head to assess cerebellar injury.
- Classification of cerebral palsy types.
Main Results:
- All 13 children exhibited severe, often symmetric, injury to the inferior cerebellar hemispheres on MRI.
- Average birthweight was 668g; gestational ages ranged from 24 to 27 weeks.
- Most children had microcephaly, intellectual disability, and visual problems; only 3 could walk.
Conclusions:
- Severe cerebellar injury is a significant, previously underappreciated finding in extremely premature infants who develop cerebral palsy.
- This injury is associated with significant neurodevelopmental deficits.
- Further research is needed to understand the underlying mechanisms.
Abstract:
We evaluated 13 children with cerebral palsy who had birthweights under 1085 g. A magnetic resonance image (MRI) of the head was obtained, the findings were compared, and the neonatal records were reviewed. The individual children were classified as to the type of cerebral palsy. On MRI, all had severe injury to the inferior cerebellar hemispheres, mostly symmetric, and in some there was injury to the inferior vermis. The average birthweight was 668 g, and the gestational ages were 24 to 27 weeks. No other outstanding prenatal or postnatal problems were identified. The children had different types of severe cerebral palsy, with only 3 being able to walk. Almost all were mentally retarded and microcephalic. All had visual problems. This report defines a previously underappreciated injury to the cerebellum in extremely premature infants. Further clinical, laboratory, and pathologic studies are needed to better define the underlying mechanisms.