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MULTICENTRE STUDIES

BRAIN NEUROSONOGRAPHY IN INFANTS FROM MOTHERS WITH POSITIVE ANTIPHOSPHOLIPID ANTIBODIES AUTOIMMUNE DISEASE

 

COORDINATORS

 

M Motta, A Angeli, ML Cardone, A Tincani, A Lojacono, G Chirico.

Neonatology and Neonatal Intensive Care Unit, Rheumatology and Clinical Immunology, Obstetrics and Gynecology. Spedali Civili – Brescia, Italy.

 

 

PROJECT

 

Cranial ultrasonography (CUS) is a noninvasive modality of neuroimaging available during infancy, mainly used for the investigation and diagnosis of a wide variety of neonatal intracranial abnormalities. We retrospectively analysed the CUS of 54 infants born from mothers with autoimmune diseases (from June 2001 to June 2005). The ultrasonographic examination of the neonatal brain was done at birth and, if intracranial abnormalities were detected, again at 1, 5 and 8 months of life.

Intracranial abnormalities were detected in 13/54 infants (24%): germinal matrix hemorrhage (GMH), subependymal cyst or echogenic lenticulostriate vessels (LSV); moreover 14/54 infants (26%) showed increased periventricular echogenicity, considered a paraphisyologic image.

To compare the incidence of intracranial abnormalities, infants were divided in two groups: 31 infants from mother with AD and positive for antiphospholipid antibodies (1-ADaPL) and 23 infants from mothers with autoimmune disease without antiphospholipid antibodies (2-AD).

The GMH, subependymal cyst and increased periventricular echogenicity showed a similar incidence in the two infants groups. The echogenic LSV were preferentially distributed in the 1-ADaPL group (Table).

 

Cranial Sonography

1-ADaPL

n = 31

2-AD

n = 23

Increased periventricular echogenicity

6

8

Echogenic LSV

6

1

GMH/ subependymal cysts

3

3

 

Neuroimaging abnormalities, which were examined up to 8 months, disappeared (increased periventricular echogenicity and echogenic LSV) or remained stable (GMH and subependymal cyst); none of these patients showed progression of the cerebral abnormalities. During follow-up (12 months) all infants has no clinical evidence of neurological disease.

Sonografic lenticulostriate vasculopathy is believed to be a nonspecific indicator of prenatal brain insult. It is observed in congenital infections, maternal drug use, birth asphyxia, chromosomal abnormalities and metabolic disorders. GMH and subependymal cyst are commonly found in preterm infants; they have been described in up to 5% of normal newborns.

The pathogenesis of neuroimaging abnormalities in infants from mothers whit autoimmune diseases is unclear. An immune-mediated endothelial dysfunction involving the cerebral vessels is one of the possible mechanisms. The finding of echogenic LSV and subependymal cyst formation supports a vascular etiology. Follow-up of these infants, as proposed by the European Register of infants from mothers whit APS, will be necessary to determine if there are any long-term sequelae.

 

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Last updated: 17 November 2005