Lenticulostriate vasculopathy also known as thalamostriate vasculopathy or mineralizing vasculopathy 1, refers to the ultrasound appearance of hyperechogenic linear or branching tubular streaks in the thalami or basal ganglia of neonates.
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Epidemiology
Lenticulostriate vasculopathy has been reported on roughly 2-5% of neonatal cranial ultrasounds 1-4. The incidence in preterm babies might be as high as 20% 9. It has been described in association with numerous diseases, most commonly congenital cytomegalovirus (CMV) infection, perinatal hypoxia, and chromosomal anomalies.
Clinical presentation
Lenticulostriate vasculopathy is most often encountered on neonatal cranial ultrasounds performed for another reason.
Pathology
It is sometimes associated with amorphous basophilic deposits in the walls of medium-sized perforating arteries 6. An initial hypercellular vasculopathy can progress to perivascular mineralization.
However, a frank pathologic correlate of the ultrasound findings has not always been found. Moreover, the sonographic anomalies have been shown to often spontaneously regress.
Radiographic features
Ultrasound
High-frequency grayscale ultrasound shows linear or branching echogenicities in the thalami or basal ganglia.
CT/MRI
Often, no convincing correlate is seen on CT or MRI. At times, punctate calcifications in the basal ganglia are noted.
Treatment and prognosis
Although lenticulostriate vasculopathy has been reported in association with countless diseases, this does not imply causation, especially since most studies have been retrospective. It can be incidentally found in neonates screened for other reasons who go on to have normal neurological development. It has been associated with a higher risk of neonatal intraventricular hemorrhage 1. There have been reported cases of basal ganglia and thalamic ischemic infarcts following minor trauma in neonates with lenticulostriate vasculopathy 9.
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