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Pediatric Radiology

, Volume 44, Issue 11, pp 1393–1402 | Cite as

Neonatal deep white matter venous infarction and liquefaction: a pseudo-abscess lesion

  • Lynne Ruess
  • Carly M. Dent
  • Hailey J. Tiarks
  • Michelle A. Yoshida
  • Jerome A. Rusin
Original Article
  • 502 Downloads

Abstract

Background

Deep white matter hemorrhagic venous infarction with subsequent cavitation due to necrosis and liquefaction has been described in neonates and may be associated with infection and meningitis. In our experience, the MRI pattern of these lesions is confused with the pattern seen with cerebral abscesses.

Objective

The purpose of our study was to characterize the MRI findings of post infarction necrosis and liquefaction after hemorrhagic deep white matter venous infarction in infants and to distinguish these lesions from cerebral abscesses.

Materials and methods

An institutional review board approved a retrospective review of imaging records to identify all patients with cerebral venous infarction at a children’s hospital during a 10-year period. Nine infants had deep white matter hemorrhagic venous infarction with white matter fluid signal cavitary lesions. A diagnosis of cerebral abscess was considered in all. The imaging and laboratory findings in these patients are reviewed and compared to descriptions of abscesses found in the literature.

Results

There were six female and three male infants. The mean age at presentation was 20 days (range: 0–90 days), while the corrected age at presentation was less than 30 days for all patients. Seven patients presented with seizures and signs of infection; one infant presented with lethargy and later proved to have protein C deficiency. MRI was performed 0–12 days from presentation in these eight patients. Another patient with known protein C deficiency underwent MRI at 30 days for follow-up of screening US abnormalities. There were a total of 38 deep cerebral white matter fluid signal cavitary lesions: 25 frontal, 9 parietal, 2 temporal, 2 occipital. Larger lesions had dependent debris. All lesions had associated hemorrhage and many lesions had evidence of adjacent small vessel venous thrombosis. Lesions imaged after gadolinium showed peripheral enhancement. Three lesions increased in size on follow-up imaging. Three patients, two with meningitis confirmed via microbiology and one with presumed meningitis by CSF counts, underwent surgical aspiration of a total of six lesions. All specimens were sent for pathology and culture and were negative for microorganisms.

Conclusion

Recognizing the MR appearance of cavitary necrosis and liquefaction after deep white matter cerebral venous infarction in neonates can distinguish this entity from cerebral abscess and potentially avoid an unnecessary neurosurgical aspiration procedure.

Keywords

Venous infarction Brain Cerebral thrombosis Necrosis Magnetic resonance imaging Neonate 

Notes

Acknowledgments

Presented at the Annual Meeting of the Society for Pediatric Radiology, San Francisco, CA April 17–20, 2012.

Conflicts of interest

None

References

  1. 1.
    Barron TF, Gusnard DA, Zimmerman RA et al (1992) Cerebral venous thrombosis in neonates and children. Pediatr Neurol 8:112–116PubMedCrossRefGoogle Scholar
  2. 2.
    Sébire G, Tabarki B, Saunders DE et al (2005) Cerebral venous sinus thrombosis in children: risk factors, presentation, diagnosis and outcome. Brain 128:477–489PubMedCrossRefGoogle Scholar
  3. 3.
    Wasay M, Dai AI, Ansari M et al (2008) Cerebral venous sinus thrombosis in children: a multicenter cohort from the United States. J Child Neurol 23:26–31PubMedCrossRefGoogle Scholar
  4. 4.
    Berfelo FJ, Kersbergen KJ, van Ommen CH et al (2011) Neonatal cerebral sinovenous thrombosis from symptom to outcome. Stroke 41:1382–1388CrossRefGoogle Scholar
  5. 5.
    Burger PC, Graham DG, Burch JG et al (1978) Hemorrhagic cerebral white matter: infarction with cerebral deep venous thrombosis and hypoxia. Arch Pathol Lab Med 102:40–42PubMedGoogle Scholar
  6. 6.
    Jan W, Zimmerman RA, Bilaniuk LT et al (2003) Diffusion-weighted imaging in acute bacterial meningitis in infancy. Neuroradiology 45:634–639PubMedCrossRefGoogle Scholar
  7. 7.
    Triulzi F, Parazzini C, Righini A (2006) Patterns of damage in the mature neonatal brain. Pediatr Radiol 36:608–620PubMedCrossRefGoogle Scholar
  8. 8.
    Kersbergen KJ, Groenendaal F, Benders MJ et al (2011) The spectrum of associated brain lesions in cerebral sinovenous thrombosis: relation to gestational age and outcome. Arch Dis Child Fetal Neonatal Ed 96:404–409CrossRefGoogle Scholar
  9. 9.
    Teksam M, Moharir M, Deveber G et al (2008) Frequency and topographic distribution of brain lesions in pediatric cerebral venous thrombosis. AJNR Am J Neuroradiol 29:1961–1965PubMedCrossRefGoogle Scholar
  10. 10.
    Nagaraj UD, Rusin JA, McBride KL et al (2013) Magnetic resonance imaging in neonatal citrullinemia. J Pediatr Neurol 2:169–173Google Scholar
  11. 11.
    Rutherford MA, Supramaniam V, Ederies A et al (2010) Magnetic resonance imaging of white matter diseases of prematurity. Neuroradiology 52:505–521PubMedCrossRefGoogle Scholar
  12. 12.
    Hedlund GL, Boyer RS (1999) Neuroimaging of postnatal pediatric central nervous system infections. Semin Pediatr Neurol 6:299–317PubMedCrossRefGoogle Scholar
  13. 13.
    Eason JD, Peacock D (1996) Plesiomonas shigelloides septicemia and meningitis in a neonate. Can J Infect Dis 7:380–382PubMedPubMedCentralGoogle Scholar
  14. 14.
    Burdette JH, Santos C (2000) Enterobacter sakazakii brain abscess in the neonate: the importance of neuroradiologic imaging. Pediatr Radiol 30:33–34PubMedCrossRefGoogle Scholar
  15. 15.
    Fanning NF, Laffan EE, Shroff MM (2006) Serial diffusion-weighted MRI correlates with clinical course and treatment response in children with intracranial pus collections. Pediatr Radiol 36:26–37PubMedCrossRefGoogle Scholar
  16. 16.
    de Oliveira RS, Pinho VF, Madureira JF et al (2007) Brain abscess in a neonate: an unusual presentation. Childs Nerv Syst 23:139–142PubMedCrossRefGoogle Scholar
  17. 17.
    Takeuchi H, Fujita Y, Ogawa H et al (2009) Multiple brain abscesses in neonate caused by Edwardsiella tarda: case report. Neurol Med Chir (Tokyo) 49:85–89CrossRefGoogle Scholar
  18. 18.
    Drazin D, Lehman D, Danielpour M (2010) Successful surgical drainage and aggressive medical therapy in a preterm neonate with Bacillus cereus meningitis. Pediatr Neurosurg 46:466–471PubMedCrossRefGoogle Scholar
  19. 19.
    Phan H, Lehman D (2012) Cerebral abscess complicating Proteus mirabilis meningitis in a newborn infant. J Child Neurol 27:405–407PubMedCrossRefGoogle Scholar
  20. 20.
    Qureshi UA, Wani NA, Charoo BA et al (2011) Klebsiella brain abscess in a neonate. Arch Dis Child Fetal Neonatal Ed 96:F19PubMedCrossRefGoogle Scholar
  21. 21.
    Barnes PD, Poussaint TY, Burrows PE (1994) Imaging of pediatric central nervous system infections. Neuroimaging Clin N Am 4:367–391PubMedGoogle Scholar
  22. 22.
    Hernández MI, Sandoval CC, Tapia JL et al (2011) Stroke patterns in neonatal group B streptococcal meningitis. Pediatr Neurol 44:282–288PubMedCrossRefGoogle Scholar
  23. 23.
    Blaser S, Jay V, Becker LE et al (2002) Neonatal brain infection. In: Rutherford M (ed) MRI of the neonatal brain. Saunders, London, pp 201–223Google Scholar
  24. 24.
    Willis J, Robinson JE (1988) Enterobacter sakazakii meningitis in neonates. Pediatr Infect Dis J 7:196–199PubMedCrossRefGoogle Scholar
  25. 25.
    Meier A, Chusid MJ, Sty JR (1998) Neonatal citrobacter meningitis: neurosonographic observations. J Ultrasound Med 17:399–401PubMedGoogle Scholar
  26. 26.
    Gallagher PG, Ball WS (1991) Cerebral infarctions due to CNS infection with Enterobacter sakazakii. Pediatr Radiol 21:135–136PubMedCrossRefGoogle Scholar
  27. 27.
    Britt RH, Enzmann DR, Yeager AS (1981) Neuropathological and computerized tomographic findings in experimental brain abscess. J Neurosurg 55:590–603PubMedCrossRefGoogle Scholar
  28. 28.
    Haimes AB, Zimmerman RD, Morgello S et al (1989) MR imaging of brain abscesses. AJR Am J Roentgenol 152:1073–1085PubMedCrossRefGoogle Scholar
  29. 29.
    Dev R, Gupta RK, Poptani H et al (1998) Role of in vivo proton magnetic resonance spectroscopy in the diagnosis and management of brain abscesses. Neurosurgery 42:37–42PubMedCrossRefGoogle Scholar
  30. 30.
    Pal D, Bhattacharyya A, Husain M et al (2010) In vivo proton MR spectroscopy evaluation of pyogenic brain abscesses: a report of 194 cases. AJNR Am J Neuroradiol 31:360–366PubMedCrossRefGoogle Scholar
  31. 31.
    Abou Zeid N, Pirko I, Erickson B et al (2012) Diffusion-weighted imaging characteristics of biopsy-proven demyelinating brain lesions. Neurology 78:1655–1662PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Hartmann M, Jansen O, Heiland S et al (2001) Restricted diffusion within ring enhancement is not pathognomonic for brain abscess. AJNR Am J Neuroradiol 22:1738–1742PubMedGoogle Scholar
  33. 33.
    Burtscher IM, Holtås S (1999) In vivo proton MR spectroscopy of untreated and treated brain abscesses. AJNR Am J Neuroradiol 20:1049–1053PubMedGoogle Scholar
  34. 34.
    Forbes KP, Pipe JG, Heiserman JE (2001) Evidence for cytotoxic edema in the pathogenesis of cerebral venous infarction. AJNR Am J Neuroradiol 22:450–455PubMedGoogle Scholar
  35. 35.
    Atlas SW, DuBois P, Singer MB et al (2000) Diffusion measurements in intracranial hematomas: implications for MR imaging of acute stroke. AJNR Am J Neuroradiol 21:1190–1194PubMedGoogle Scholar
  36. 36.
    Hsu LC, Lirng JF, Fuh JL et al (1998) Proton magnetic resonance spectroscopy in deep cerebral venous thrombosis. Clin Neurol Neurosurg 100:27–30PubMedCrossRefGoogle Scholar
  37. 37.
    Govaert P, Ramenghi L, Toal R et al (2009) Diagnosis of perinatal stroke 1: definitions, differential diagnosis and registration. Acta Paediatr 98:1720–1726PubMedCrossRefGoogle Scholar
  38. 38.
    Gould SJ, Howard S, Hope PL et al (1987) Periventricular intraparenchymal cerebral haemorrhage in preterm infants: the role of venous infarction. J Pathol 151:197–202PubMedCrossRefGoogle Scholar
  39. 39.
    Takashima S, Mito T, Ando Y (1986) Pathogenesis of periventricular white matter hemorrhages in preterm infants. Brain Dev 8:25–30PubMedCrossRefGoogle Scholar
  40. 40.
    Dudink J, Lequin M, Weisglas-Kuperus N et al (2008) Venous subtypes of preterm periventricular haemorrhagic infarction. Arch Dis Child Fetal Neonatal Ed 93:201–206CrossRefGoogle Scholar
  41. 41.
    Foreman SD, Smith EE, Ryan NJ et al (1984) Neonatal Citrobacter meningitis: pathogenesis of cerebral abscess formation. Ann Neurol 16:655–659PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Lynne Ruess
    • 1
    • 2
  • Carly M. Dent
    • 1
  • Hailey J. Tiarks
    • 1
  • Michelle A. Yoshida
    • 1
  • Jerome A. Rusin
    • 1
    • 2
  1. 1.Department of RadiologyNationwide Children’s HospitalColumbusUSA
  2. 2.The Ohio State University College of Medicine and Public HealthColumbusUSA

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