NEUROPATHOLOGIC ASSESSMENT AND CLINICAL CORRELATES OF CHOROID PLEXUS HEMORRHAGE (CPH) IN A NEONATAL AUTOPSY POPULATION

Abstract

To determine the incidence of neuropathologically-proven CPH and its correlation to birthweight (BW), gestational age (GA) and intrauterine growth, we reviewed the clinical courses and cranial postmortems of 81 consecutive neonates ≥500g BW who died between 6/1/80-5/31/82. Study cases represented 63% of all NICU deaths with specific exclusions for CNS malformations, severe brain autolysis and lack of parental permission for cranial postmortem. All post-mortem specimens were reviewed by a neuropathologist to determine intracranial hemorrhage (ICH) sites and extension.No hemorrhages were detected in 26 infants. Fifty-five of 81 infants had ICH (68%). Sites of ICH included periventricular (PVH;n=43) intraventricular (IVH;n=38), cerebellar (CBH;n=4), subarachnoid (SAH;n=49), and choroid plexus (CPH;n=9) areas. CPH accounted for 16% of the infants with ICH. Five of the 9 infants with CPH were ≤ 1500g BW and appropriate for GA (AGA). Two infants were between 1501-2500g BW (one AGA; one small for GA (SGA)). Of the 2 infants >2500g BW, 1 was AGA and 1 was large for GA (LGA). Isolated CPH occurred in only 1 infant (Term,LGA). CPH was the only site of initiation of IVH in 4 infants (1 Term AGA;1 Term SGA;2 Pre-Term AGA). The 4 remaining infants with CPH also had PVH with IV extension (4≤1500g, AGA). This study defines the incidence of CPH in a neonatal autopsy population and shows that CPH occurs not only in gestationally mature infants but frequently occurs in pre-term AGA infants as well. It also shows that since CPH rarely occurs as an isolated phenomenon in those babies who die, the pre-mortem diagnosis of CPH may be obscured by the existence of other sites of ICH.