Abstract
SUMMARY: Fetal vascular malperfusion includes a continuum of placental histologic abnormalities increasingly associated with perinatal brain injury, namely arterial ischemic stroke. Here, we describe the clinical-neuroimaging features of 5 neonates with arterial ischemic stroke and histologically proved fetal vascular malperfusion. All infarcts involved the anterior territories and were multiple in 2 patients. In 2 neonates, there were additional signs of marked dural sinus congestion, thrombosis, or both. A mixed pattern of chronic hypoxic-ischemic encephalopathy and acute infarcts was noted in 1 patient at birth. Systemic cardiac or thrombotic complications were present in 2 patients. These peculiar clinical-radiologic patterns may suggest fetal vascular malperfusion and should raise the suspicion of this rare, underdiagnosed condition carrying important implications in patient management, medicolegal actions, and future pregnancy counseling.
ABBREVIATIONS:
- FVM
- fetal vascular malperfusion
- PAIS
- perinatal arterial ischemic stroke
Footnotes
This work was supported by funds of Compagnia San Paolo (Reaserch Grant to MDR; SIME 2017-0621, ROL 20573), the “Associazione per la Lotta all’IctusCerebrale” (ALICe) and “Ricerca Corrente 2020 (linea 5)” of the Italian Ministry of Health, assigned to Rehabilitation Unit of IRCCS Giannina Gaslini. These sponsors had no involvement in any of the study steps: design, data collection, analysis, and interpretation, writing of the report, and following submission.
Ethics approval: All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was waived due to retrospective nature of the study.
Disclosures: Ana Geraldo—UNRELATED: Grants/Grants Pending: ESNR, Comments: Annual Research Fellowship in diagnostic neuroradiology, paid to individual. Alessandro Parodi—RELATED: Grant: Compagnia di San Paolo (ROL 20573), Associazione per la Lotta all’IctusCerebrale (ALICe) and Ricerca Corrente Disordini Neurologici e Muscolari (Linea 5) of Italian Ministry of Health*; UNRELATED: Consultancy: Shire HGT, Comments: Consultancy for assessment of cranial ultrasound examinations from ROPP-2008-01 Study. Marta Bertamino—RELATED: Grant: Compagnia di San Paolo (ROL 20573), ALICe and Ricerca Corrente Disordini Neurologici e Muscolari (Linea 5) of Italian Ministry of Health*. Compagnia di San Paolo (ROL 20573), the ALICe and Ricerca Corrente Disordini Neurologici e Muscolari (Linea 5) of Italian Ministry of Health*. Sara Uccella—RELATED: Grant: Compagnia di San Paolo (ROL 20573), ALICe and Ricerca Corrente Disordini Neurologici e Muscolari (Linea 5) of Italian Ministry of Health*. Paolo Moretti—RELATED: Grant: Compagnia San Paolo (ROL 20573); the ALIC) and Ricerca Corrente Disordini Neurologici e Muscolari (Linea 5) of Italian Ministry of Health*. Mariasavina Severino—RELATED: Grant: Compagnia di San Paolo (ROL 20573), ALICe and Ricerca Corrente Disordini Neurologici e Muscolari (Linea 5) of Italian Ministry of Health, Comments: These sponsors had no involvement in any of the study steps: design, data collection, analysis, and interpretation, writing of the report, and following submission*; UNRELATED: Employment: Neuroradiology consultant, IRCCS Istituto Giannina Gaslini. Luca Ramenghi—RELATED: Grant: Compagnia di San Paolo (ROL 20573), ALICe and Ricerca Corrente Disordini Neurologici e Muscolari (Linea 5) of Italian Ministry of Health*; UNRELATED: Employment: IRCCS Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Children’s Sciences, University of Genoa, Genoa, Italy, Comments: Chief of Mother-Baby Department. *Money paid to the institution.
- © 2020 by American Journal of Neuroradiology
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