深髓静脉(DMV)血栓形成是早产和足月新生儿脑损伤的罕见原因。在这项研究中,我们的目标是收集临床和放射学表现的数据,治疗,和新生儿DMV血栓形成的结果。
在PubMed,ClinicalTrial.gov,Scopus,和WebofScience至2022年12月。
对75例已发表的DMV血栓形成病例进行了鉴定和分析(早产新生儿占46%)。新生儿窘迫,呼吸复苏,34/75(45%)的患者存在强迫剂或需要。出现时的体征和症状包括癫痫发作(38/75,48%),呼吸暂停(27/75,36%),嗜睡或烦躁(26/75,35%)。在磁共振成像(MRI),在所有病例中均记录了扇形线性T2低信号病变.都有缺血损伤,最常累及额叶(62/74,84%)和顶叶(56/74,76%)。53/54(98%)出现出血性梗塞的迹象。在纳入的任何研究中均未提及抗血栓治疗。尽管死亡率很低(2/75,2.6%),很大一部分患者出现了神经系统后遗症(19/51[37%]的患者出现了智力障碍,9/51[18%]的患者出现了癫痫).
在文献中很少发现DMV血栓形成,即使它可能被低估或报告不足。新生儿年龄的表现是癫痫发作和非特异性全身体征/症状,通常会导致诊断延迟,尽管有典型的核磁共振图像。发病率高,这决定了巨大的社会和健康成本,需要进一步深入研究,旨在早期诊断和循证预防和治疗策略。
Deep medullary vein (DMV) thrombosis is a rare cause of brain damage in both preterm and full-term neonates. In this study, we aimed to collect data on clinical and radiological presentation, treatment, and outcome of neonatal DMV thrombosis.
Systematic literature review on neonatal DMV thrombosis was carried out in PubMed, ClinicalTrial.gov, Scopus, and Web of Science up to December 2022.
Seventy-five published cases of DMV thrombosis were identified and analysed (preterm newborns were 46%). Neonatal distress, respiratory resuscitation, or need for inotropes were present in 34/75 (45%) of patients. Signs and symptoms at presentation included seizures (38/75, 48%), apnoea (27/75, 36%), lethargy or irritability (26/75, 35%). At magnetic resonance imaging (MRI), fan-shaped linear T2 hypointense lesions were documented in all cases. All had ischaemic injuries, most often involving the frontal (62/74, 84%) and parietal lobes (56/74, 76%). Signs of haemorrhagic infarction were present in 53/54 (98%). Antithrombotic treatment was not mentioned in any of the studies included. Although mortality was low (2/75, 2.6%), a large proportion of patients developed neurological sequelae (intellectual disability in 19/51 [37%] and epilepsy in 9/51 [18%] cases).
DMV thrombosis is rarely identified in the literature, even if it is possibly under-recognized or under-reported. Presentation in neonatal age is with seizures and non-specific systemic signs/symptoms that often cause diagnostic delay, despite the pathognomonic MRI picture. The high rate of morbidity, which determines significant social and health costs, requires further in-depth studies aimed at earlier diagnosis and evidence-based prevention and therapeutic strategies.