Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia.
Centre for Neuromuscular and Neurological disorders (Perron Institute), University of Western Australia, Perth, WA, Australia.
Neuroradiology. 2024 Oct;66(10):1837-1847. doi: 10.1007/s00234-024-03418-8. Epub 2024 Jul 3.
Infants undergoing CSF shunting procedures face a rare complication which we propose to rename "Widespread Haemorrhages in Infants Post-Shunting" (WHIPS) to better capture this unique phenomenon specific to infants undergoing CSF diversion. Our objective is to analyse the risk factors for WHIPS development and provide a detailed neuroradiological description of these haemorrhages.
A radiology information system (RIS) was searched using the search terms "shunt" and/or "catheter" and/or "drain" and/or "ventriculoperitoneal" and/or "VP" between September 2008 to January 2021 for patients < 12 months of age. Clinical data was compiled for each patient meeting the inclusion criteria. Included cases were reviewed by three radiologists for the presence of WHIPS with calculation of the bifrontal ratio and documenting haemorrhage number, morphology, location and lobar distribution.
51 patients met inclusion criteria, 8 WHIPS patients and 43 controls. There was a statistically significant correlation between a larger post-op head circumference and WHIPS (p = 0.04). WHIPS was associated with post-haemorrhagic hydrocephalus and post-infectious hydrocephalus (p = 0.009). WHIPS were identified in the cortico-subcortical regions, periventricular white matter, and deep white matter. Haemorrhages were either punctate, ovoid or confluent. Haemorrhages ranged from single to innumerable.
WHIPS represent a rare and under-recognised complication of CSF shunting unique to the infantile population. We postulate deep and superficial medullary venous haemorrhage as an underlying mechanism related to disordered intracranial hydrodynamics which are exacerbated in the infantile population due to underdeveloped arachnoid granulations and a compliant skull.
接受脑脊液分流术的婴儿面临一种罕见的并发症，我们建议将其重新命名为“分流后婴儿广泛出血（WHIPS）”，以更好地描述这种在接受脑脊液分流的婴儿中特有的独特现象。我们的目的是分析 WHIPS 发生的危险因素，并详细描述这些出血的神经放射学特征。
使用放射学信息系统（RIS），通过搜索“分流”和/或“导管”和/或“引流”和/或“脑室腹腔”和/或“VP”等术语，对 2008 年 9 月至 2021 年 1 月期间年龄<12 个月的患者进行搜索。为符合纳入标准的每位患者收集临床数据。由三位放射科医生对纳入病例进行 WHIPS 存在的评估，计算双额比值，并记录出血数量、形态、位置和叶分布。
51 例患者符合纳入标准，其中 8 例为 WHIPS 患者，43 例为对照组。术后头围较大与 WHIPS 之间存在统计学显著相关性（p=0.04）。WHIPS 与出血后脑积水和感染后脑积水有关（p=0.009）。WHIPS 见于皮质下区域、脑室周围白质和深部白质。出血呈点状、卵圆形或融合状。出血从单发至无数。
WHIPS 代表一种罕见且未被充分认识的 CSF 分流术婴儿特有并发症。我们推测深部和浅部髓内静脉出血是一种潜在机制，与颅内血流动力学紊乱有关，在婴儿中，由于蛛网膜颗粒发育不良和颅骨顺应性增加，这种紊乱会加剧。
