分流术后婴儿广泛出血(WHIPS):一种罕见且认识不足的现象的临床特征、风险因素和神经影像学特征。

IF 2.4 3区 医学 Q2 CLINICAL NEUROLOGY
Neuroradiology Pub Date : 2024-10-01 Epub Date: 2024-07-03 DOI:10.1007/s00234-024-03418-8
Rahul Lakshmanan, Fariza Abu Hassan, Shashini Dissanayake, Harriet Crabtree, Aden McLaughlin, Matthew Cooper, Sharon Lee, Richard Warne, Peter Shipman
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引用次数: 0

摘要

目的:接受脑脊液分流术的婴儿面临着一种罕见的并发症,我们建议将其重新命名为 "分流术后婴儿广泛出血"(WHIPS),以更好地捕捉这一接受脑脊液分流术的婴儿特有的现象。我们的目标是分析 WHIPS 发生的风险因素,并对这些出血提供详细的神经放射学描述:2008年9月至2021年1月期间,使用 "分流器 "和/或 "导管 "和/或 "引流管 "和/或 "脑室腹腔 "和/或 "VP "等检索词对放射学信息系统(RIS)中的患者进行检索:51例患者符合纳入标准,其中8例为WHIPS患者,43例为对照组。术后头围增大与 WHIPS 存在统计学意义上的显著相关性(p = 0.04)。WHIPS 与出血性脑积水术后和感染性脑积水术后相关(p = 0.009)。在皮质-皮质下区域、脑室周围白质和深部白质中均可发现 WHIPS。出血呈点状、卵圆形或汇合状。出血点从单个到无数不等:WHIPS 是一种罕见的、未得到充分认识的脑脊液分流并发症,在婴幼儿中独一无二。我们推测深浅髓静脉出血是与颅内流体力学紊乱有关的潜在机制,而婴幼儿由于蛛网膜肉芽发育不全和头骨顺应性差,颅内流体力学紊乱会加剧这种情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Widespread haemorrhages in infants post-shunting (WHIPS): clinical features, risk factors and neuroimaging characteristics of a rare and under-recognised phenomenon.

Widespread haemorrhages in infants post-shunting (WHIPS): clinical features, risk factors and neuroimaging characteristics of a rare and under-recognised phenomenon.

Purpose: Infants undergoing CSF shunting procedures face a rare complication which we propose to rename "Widespread Haemorrhages in Infants Post-Shunting" (WHIPS) to better capture this unique phenomenon specific to infants undergoing CSF diversion. Our objective is to analyse the risk factors for WHIPS development and provide a detailed neuroradiological description of these haemorrhages.

Materials and methods: A radiology information system (RIS) was searched using the search terms "shunt" and/or "catheter" and/or "drain" and/or "ventriculoperitoneal" and/or "VP" between September 2008 to January 2021 for patients < 12 months of age. Clinical data was compiled for each patient meeting the inclusion criteria. Included cases were reviewed by three radiologists for the presence of WHIPS with calculation of the bifrontal ratio and documenting haemorrhage number, morphology, location and lobar distribution.

Results: 51 patients met inclusion criteria, 8 WHIPS patients and 43 controls. There was a statistically significant correlation between a larger post-op head circumference and WHIPS (p = 0.04). WHIPS was associated with post-haemorrhagic hydrocephalus and post-infectious hydrocephalus (p = 0.009). WHIPS were identified in the cortico-subcortical regions, periventricular white matter, and deep white matter. Haemorrhages were either punctate, ovoid or confluent. Haemorrhages ranged from single to innumerable.

Conclusions: WHIPS represent a rare and under-recognised complication of CSF shunting unique to the infantile population. We postulate deep and superficial medullary venous haemorrhage as an underlying mechanism related to disordered intracranial hydrodynamics which are exacerbated in the infantile population due to underdeveloped arachnoid granulations and a compliant skull.

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来源期刊
Neuroradiology
Neuroradiology 医学-核医学
CiteScore
5.30
自引率
3.60%
发文量
214
审稿时长
4-8 weeks
期刊介绍: Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.
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