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Ann Neurol ; 81(2): 278-286, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28076893

RESUMEN

OBJECTIVE: Although vein of Galen aneurysmal malformations (VGAM) can be diagnosed in the fetus, the challenge is predicting the occurrence of its 2 major complications: cardiopulmonary failure and encephalomalacia. This study attempts to determine which fetal brain magnetic resonance imaging (MRI) features might be used to predict the development of these complications at birth. METHODS: The cohort was extracted from a prospectively assembled database of VGAM cases managed at a single referral center from 2000 to 2014. Of 251 patients with VGAM, 83 cases were diagnosed prenatally. A total of 58 patient charts having at least 1 fetal MRI were reviewed. Patterns of brain parenchyma, hydrocephalus, and so-called middle cerebral artery (MCA) "pseudofeeders" were correlated with cardiac failure, pulmonary hypertension, and encephalomalacia at birth. RESULTS: The median gestational age at fetal MRI was 32.3 weeks of pregnancy (±2.3). Nine fetuses (16%) had encephalomalacia. Thirty-one fetuses (53%) had MCA pseudofeeders. Twenty-six fetuses (45%) had prenatal hydrocephalus. Prenatal MCA pseudofeeders were a risk factor for encephalomalacia at birth (p = 0.001). MCA pseudofeeders and hydrocephalus were risk factors for both severe cardiac failure (p = 0.01 and p = 0.04, respectively) and severe pulmonary hypertension (p = 0.014 and p = 0.05, respectively) at birth. INTERPRETATION: MCA pseudofeeders are the result of impaired cerebral blood flow, and are thus a risk factor for further brain melting at birth. Their presence can be used for informing parents and as an aid in management decisions. Ann Neurol 2017;81:278-286.


Asunto(s)
Encefalomalacia/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Hidrocefalia/diagnóstico por imagen , Hipertensión Pulmonar/diagnóstico , Arteria Cerebral Media/diagnóstico por imagen , Malformaciones de la Vena de Galeno/diagnóstico , Adulto , Encefalomalacia/etiología , Femenino , Edad Gestacional , Insuficiencia Cardíaca/etiología , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Embarazo , Diagnóstico Prenatal , Pronóstico , Factores de Riesgo , Malformaciones de la Vena de Galeno/complicaciones
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