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Cerebral microbleeds after use of extracorporeal membrane oxygenation in children
David S Liebeskind1, Nerses Sanossian, Monica L Sapo
1UCLA Stroke Center, University of California Los Angeles, Los Angeles, CA 90095-1769, USA. davidliebeskind@yahoo.com
Abstract:
Cerebral microbleeds (CMB) on gradient-recalled echo (GRE) magnetic resonance imaging (MRI) are rarely seen in children, yet have been described following vascular procedures in adults. Extracorporeal membrane oxygenation (ECMO) has been associated with vascular injury and neurological events in children, but there have been no reports to date of GRE MRI findings in children treated with ECMO. We reviewed MRI scans for all vascular neurology consultations in children treated with ECMO at an academic medical center over a 5-year period. In 6 of 12 cases, GRE was acquired as others were unstable or had contraindications to MRI. All 6 of 6 (100%) GRE cases (mean age 2.1 years, 7 female, 5 male) demonstrated CMB. CMB were multiple (>3 lesions), situated in cortical or lobar regions, with a striking predominance (5/6 cases) for the right carotid distribution. Other than CMB, no cases demonstrated intracranial hemorrhage. CMB may be noted on GRE MRI after ECMO and may reflect vascular damage from gaseous emboli.
Insights
Cerebral microbleeds (CMB) are common in children on extracorporeal membrane oxygenation (ECMO) as seen on gradient-recalled echo (GRE) MRI. These findings suggest potential vascular damage from gaseous emboli during ECMO treatment.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Cerebral microbleeds (CMB) are rare in children but seen in adults after vascular procedures.
- Extracorporeal membrane oxygenation (ECMO) is linked to neurological issues in children.
- No prior reports exist on GRE MRI findings in pediatric ECMO patients.
Observation:
- Retrospective review of pediatric vascular neurology consultations over 5 years.
- Gradient-recalled echo (GRE) MRI was acquired in 6 of 12 pediatric ECMO cases.
- All 6 cases with GRE MRI (mean age 2.1 years) showed CMB.
Findings:
- 100% of pediatric ECMO patients with GRE MRI demonstrated CMB.
- CMB were multiple, cortical/lobar, with right carotid distribution predominance.
- No other intracranial hemorrhages were observed.
Implications:
- CMB are a notable finding on GRE MRI in children treated with ECMO.
- Findings may indicate vascular damage resulting from gaseous emboli.
- Highlights the utility of GRE MRI in assessing neurological complications in pediatric ECMO.
