title: Asymmetrical myelination of the posterior limb of the internal capsule in infants with periventricular haemorrhagic infarction: an early predictor of hemiplegia.
abstract: OBJECTIVE
  To prospectively assess the predictive value of asymmetrical myelination on MRI of the posterior limb of the internal capsule (PLIC) in newborn infants with an intraventricular haemorrhage (IVH) associated with unilateral haemorrhagic parenchymal involvement (PI), for subsequent development of a hemiplegia.
  
  
  METHODS
  12 preterm infants (GA 25-36 wks) and 4 full-term infants were studied. Using cranial ultrasound (US), the pre-term infants were diagnosed to have an IVH with unilateral PI. The term infants presented with a porencephalic cyst (PC) on the first postnatal US, following an antenatal IVH with PI. MRI was performed at 40 wks postmenstrual age in the pre-term infants and during the first 2 weeks of life in the full-term infants, using a 1.5T magnet. Using an inversion recovery sequence, the myelination of the internal capsule was recorded as normal, abnormal or equivocal. Neurological assessment > or = 12 months disclosed the presence of a hemiplegia or asymmetry in tone pattern.
  
  
  RESULTS
  All 4 cases with a normal internal capsule had a normal outcome in spite of the development of a PC. All 9 cases with an abnormal PLIC developed a hemiplegia, while 1 of the 3 cases with an equivocal PLIC is normal on neurological assessment, one developed a mild asymmetry in tone and 1 a mild hemiplegia.
  
  
  CONCLUSIONS
  While a symmetrical signal intensity within the internal capsule on MRI, performed at 40 weeks PMA, in infants with an IVH and unilateral PI appears to be strongly related to a normal outcome, an asymmetrical PLIC is an early predictor of future hemiplegia.
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: L S
authors.initials: LS
authors.lastname: De Vries
authors.forename: F
authors.initials: F
authors.lastname: Groenendaal
authors.forename: I C
authors.initials: IC
authors.lastname: van Haastert
authors.forename: P
authors.initials: P
authors.lastname: Eken
authors.forename: K J
authors.initials: KJ
authors.lastname: Rademaker
authors.forename: L C
authors.initials: LC
authors.lastname: Meiners
mesh_terms: D002544:Cerebral Infarction / Q000150:complications / Q000175:diagnosis*; D004453:Echoencephalography; D005865:Gestational Age; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis*; D020772:Internal Capsule / Q000002:abnormalities / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies