[Cerebrovascular disorders in preterm neonates]

To review the etiology, pathogenesis, clinical manifestations, diagnosis and treatment of cerebrovascular disorders (CVD) in preterm neonates.

The germinal matrix-intraventricular hemorrhage (GM-IVH) is the most frequent intracranial hemorrhage. The pathogenesis includes intravascular, vascular and extravascular factors. The neuropathologic lesion is the hemorrhage within the subependymal GM. There are four degrees of severity. Clinical manifestations include three syndromes: catastrophic, saltatory and silent. Treatment is prophylactic. Periventricular hemorrhagic infarct is of venous origin, might be associated to GM-IVH and is difficult to differentiate from periventricular leukomalacia (PVL). Cerebellar hemorrhage frequency increases with decreasing gestational age. It may be asymptomatic or manifest with a non-specific neurologic picture. PVL is the most important ischemic lesion. Its pathogenesis includes anatomic, physiologic, maturational, biochemical, infectious and immunologic factors. The neuropathologic lesion is focal necrosis in the terminal distribution of the long penetrating arteries. Treatment is prophylactic. Other ischemic lesions are ischemic arterial infarct, cerebellar infarct, telencephalic leukoencephalopathy and pontosubicular necrosis. CVD diagnostic tests include cerebral ultrasound, computed tomography, magnetic resonance imaging and spectroscopy and electroencephalogram. Mortality of some CVD is high and some others are associated with a high risk of cerebral palsy and cognitive deficits.

CVD are common in preterm neonates and represent an important cause of neurologic disease in the child.