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Large postnatally acquired porencephalic cysts: unexpected developmental outcomes
J A Blackman1, G A McGuinness, J F Bale
1Department of Pediatrics, University of Iowa, Iowa City.
Insights
Infants with posthemorrhagic intraparenchymal cysts often have motor deficits but may have better cognitive outcomes than expected. Neonatal seizures and cyst location influenced neurodevelopmental results.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Posthemorrhagic intraparenchymal cysts are a complication of severe intraventricular hemorrhage in infants.
- The neurodevelopmental outcomes for these infants are often presumed to be poor, particularly concerning cognitive function.
Purpose of the Study:
- To evaluate the neurodevelopmental outcomes in infants diagnosed with posthemorrhagic intraparenchymal cysts.
- To identify factors associated with better or worse neurodevelopmental trajectories in this population.
Main Methods:
- Retrospective review of clinical, ultrasonographic, and developmental data.
- Assessment of cognitive and motor outcomes at a mean follow-up age of 33 months.
- Statistical analysis to determine relationships between neonatal factors and outcomes.
Main Results:
- Most children (n=16) exhibited motor deficits, with spastic cerebral palsy in 81%.
- Cognitive outcomes varied: 31% had normal cognition (DQ/IQ > 83), 56% had borderline to mild deficits (DQ/IQ 52-83), and 19% had moderate to severe deficits (DQ/IQ < 52).
- Normal cognitive outcomes were associated with fewer neonatal seizures and more localized cysts.
Conclusions:
- Motor deficits are common in infants with severe intraventricular hemorrhage and resulting porencephalic cysts.
- Cognitive outcomes may be more favorable than previously assumed, suggesting potential for intervention and support.
- Early identification of neonatal seizures and cyst characteristics may aid in predicting neurodevelopmental trajectories.
Abstract:
To determine the neurodevelopmental outcome for infants with posthemorrhagic intraparenchymal cysts, we reviewed retrospectively clinical, ultrasonographic, and developmental features in 16 affected children. At a mean follow-up age of 33 months, five subjects had normal cognitive outcomes (developmental quotient [DQ] or IQ greater than 83), nine had borderline to mild deficits (DQ or IQ, 52 to 83), but only three had moderate to severe deficits (DQ or IQ less than 52). Spastic cerebral palsy was present in 13 (81%); only one child (6%) had a chronic seizure disorder requiring medication. Cognitively normal children were less likely to have had neonatal seizures (P less than .05) and tended to have more localized cysts. Otherwise, we found no relationship between outcome and neonatal clinical or laboratory findings. Overall, these results suggest that although motor deficits are common in infants with severe intraventricular hemorrhage and porencephalic cysts, cognitive outcomes may be more favorable than has been suspected previously.