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Published on: October 28, 2022
The Cerebellar-Cerebral Microstructure Is Disrupted at Multiple Sites in Very Preterm Infants with Cerebellar
Vera Neubauer1, Tanja Djurdjevic, Elke Griesmaier
1Department of Paediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria.
Insights
Cerebellar haemorrhage (CBH) in preterm infants significantly impacts white matter pathways, affecting both local and remote brain regions. This early injury disrupts cerebellar-cerebral connections, potentially explaining long-term cognitive and affective issues.
Area of Science:
- Neonatal Neurology
- Neuroimaging
- Developmental Neuroscience
Background:
- Advances in MRI necessitate re-evaluating brain injury in preterm infants.
- The cerebellum's role in adverse outcomes is increasingly recognized.
- The impact of cerebellar haemorrhage (CBH) on cerebellar-cerebral microstructure remains understudied.
Purpose of the Study:
- To examine how CBH affects the microstructure of cerebellar-cerebral connections in preterm infants (<32 weeks gestational age).
Main Methods:
- Diffusion tensor MRI was used to assess brain microstructure in preterm infants at term-equivalent age.
- Cerebellar haemorrhage (CBH) and supratentorial injuries were scored.
- Fractional anisotropy (FA) and apparent diffusion coefficient were measured in key brain regions, including the centrum semiovale, internal capsule, corpus callosum, and cerebellar peduncles.
Main Results:
- Infants with CBH exhibited significantly lower FA values across all measured regions compared to those without CBH.
- Isolated CBH was associated with reduced FA in the middle and superior cerebellar peduncles and the posterior limb of the internal capsule.
Conclusions:
- CBH leads to alterations in both local and distant white matter (WM) pathways in the developing brain.
- Disrupted cerebellar-cerebral microstructure supports the concept of developmental diaschisis.
- Early cerebellar injury may explain later cognitive and affective impairments.
Background:
Recent advances in magnetic resonance imaging (MRI) techniques have prompted reconsideration of the anatomical correlates of adverse outcomes in preterm infants. The importance of the contribution made by the cerebellum is now increasingly appreciated. The effect of cerebellar haemorrhage (CBH) on the microstructure of the cerebellar-cerebral circuit is largely unexplored.
Objectives:
To investigate the effect of CBH on the microstructure of cerebellar-cerebral connections in preterm infants aged <32 gestational weeks.
Methods:
Infants underwent diffusion tensor MRI at term-equivalent age. MRI was evaluated for CBH and additional supratentorial brain injury using a validated scoring system. Region of interest-based measures of brain microstructure (fractional anisotropy [FA] and apparent diffusion coefficient) were quantified in 5 vulnerable regions (the centrum semiovale, posterior limb of the internal capsule, corpus callosum, and superior and middle cerebellar peduncles). Group differences between infants with CBH and infants without CBH were assessed.
Results:
There were 267 infants included in the study. Infants with CBH (isolated and combined) had significantly lower FA values in all regions investigated. Infants with isolated CBH showed lower FA in the middle and superior cerebellar peduncles and in the posterior limb of the internal capsule.
Conclusions:
This study provides evidence that CBH causes alterations in localised and remote WM pathways in the developing brain. The disruption of the cerebellar-cerebral microstructure at multiple sites adds further support for the concept of developmental diaschisis, which is propagated as an explanation for the consequences of early cerebellar injury on cognitive and affective domains.
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