Telehealth Versus In-Person Injection Instruction for Adolescents and Young Adults Initiating Gender-Affirming Testosterone Therapy.

The neonatal period is a time of high risk for neurovascular injury[,]. This can include either ischemic injury or venous strokes, which account for 7–30 percent of neonatal strokes. Although features of neonatal cerebral sinus venous thrombosis (CSVT) have been well-described, advancements in MRI technology have led to increasing awareness of thrombosis or congestion of the deep medullary veins [,]. The deep medullary veins drain the central white matter, converging into larger collector vessels that ultimately empty into the subependymal veins of the lateral ventricles []. Deep medullary vein thrombosis (DMVT) can occur with or without CSVT and has been specifically associated with neonates.. Descriptions of DMVT have been primarily limited to case reports and small single center case series, which have suggested an association with neurodevelopmental impairment (NDI) [–]. Radiographically, DMVT is best visualized with MRI, and is characterized by engorgement of the deep medullary veins on T2-weighted or SWAN sequences [–]. DMVT can lead to parenchymal injury, but there is a lack of consensus on common patterns of injury and radiological risk factors for NDI []. Benninger et al established a foundation for assessment of DMVT by developing a comprehensive 102-point scoring system [] This approach has significantly advanced our understanding of DMVT-related injury patterns and radiographic analysis but requires substantial neuroradiology expertise. The aim of our study was to analyze demographic, clinical, and radiographic features of our large single-center cohort of infants with radiographically identified neonatal DMVT and to create a complementary, simplified MRI grading system that could be readily applied in clinical settings to inform neurodevelopmental outcomes in this population.