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Arca G, Núñez C, Stephan-Otto C, Arnaez J, Agut T, Cordeiro M, Boronat N, Lubián-López S, Benavente-Fernández I, Valverde E, Garcia-Alix A. Massive Neonatal Arterial Ischemic Stroke. Pediatr Neurol 2023; 144:5-10. [PMID: 37087915 DOI: 10.1016/j.pediatrneurol.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Massive infarction in adults is a devastating entity characterized by signs of extreme swelling of the brain's parenchyma. We explored whether a similar entity exists in neonates, which we call massive neonatal arterial ischemic stroke (M-NAIS), and assess its potential clinical implications. METHODS Prospective multicenter cohort study comprising 48 neonates with gestational age ≥35 weeks with middle cerebral artery (MCA) NAIS was performed. Diagnosis with magnetic resonance imaging (MRI) was performed within the first three days after symptom onset. The presence of signs of a space-occupying mass, such as brain midline shift and/or ventricular and/or extra-axial space collapse, was recorded. The volume of the infarct and brain midline shift were determined with semiautomatic procedures. Neurodevelopment was assessed at age 24 months. RESULTS Fifteen (31%) neonates presented MRI signs of a space-occupying mass effect and were considered to have an M-NAIS. The relative volume (infarct volume/total brain volume) of the infarct was on average significantly greater in the M-NAIS subgroup (29% vs 4.9%, P < 0.001). Patients with M-NAIS consistently presented lesions involving the M1 arterial territory of the MCA and showed more apneic and tonic seizures, which had an earlier onset and lasted longer. Moderate to severe adverse neurodevelopmental outcomes were present in most M-NAIS cases (79% vs 6%, P < 0.001). CONCLUSIONS M-NAIS appears to be a distinctive subtype of neonatal infarction, defined by characteristic neuroimaging signs. Neonates with M-NAIS frequently present a moderate to severe adverse outcome. Early M-NAIS identification would allow for prompt, specific rehabilitation interventions and would provide more accurate prognostic information to families.
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Affiliation(s)
- Gemma Arca
- Department of Neonatology, Hospital Clínic, IDIBAPS, Barcelona, Spain; Nene Foundation, Madrid, Spain.
| | - Christian Núñez
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Mental Health Research Group, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Christian Stephan-Otto
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Pediatric Computational Imaging Group (PeCIC), Hospital Sant Joan de Déu, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Juan Arnaez
- Nene Foundation, Madrid, Spain; Department of Neonatology, Hospital Universitario de Burgos, Burgos, Spain
| | - Thais Agut
- Nene Foundation, Madrid, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Department of Neonatology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Malaika Cordeiro
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Nuria Boronat
- Department of Neonatology, University and Politechnic Hospital La Fe, Health Research Institute La Fe, Valencia, Spain
| | - Simón Lubián-López
- Nene Foundation, Madrid, Spain; Department of Neonatology, Puerta del Mar University Hospital, Cádiz, Spain; Department of Pediatrics, Institute for Research and Innovation in Biomedical Sciences (INiBICA), Cádiz, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
| | - Isabel Benavente-Fernández
- Nene Foundation, Madrid, Spain; Department of Neonatology, Puerta del Mar University Hospital, Cádiz, Spain; Department of Pediatrics, Institute for Research and Innovation in Biomedical Sciences (INiBICA), Cádiz, Spain
| | - Eva Valverde
- Nene Foundation, Madrid, Spain; Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Alfredo Garcia-Alix
- Nene Foundation, Madrid, Spain; Professor in Iberoamerican Society of Neonatology (SIBEN), Buenos Aires, Argentina
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Ilves N, Männamaa M, Laugesaar R, Ilves N, Loorits D, Vaher U, Kool P, Ilves P. Language lateralization and outcome in perinatal stroke patients with different vascular types. BRAIN AND LANGUAGE 2022; 228:105108. [PMID: 35334446 DOI: 10.1016/j.bandl.2022.105108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/06/2021] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
Perinatal stroke affects child's language development and can change language lateralization. Language generation and comprehension tasks in functional magnetic resonance imaging were used to determine language lateralization in term born children with perinatal left-side arterial ischemic stroke (AIS) (n = 9, mean age (SD) 13.4 (3.1) y.) and periventricular venous infarction (PVI) (n = 12, 11.8 (2.8) y.), and in healthy right-handed controls (n = 30, 11.6 (2.6) y.). Lateralization index was calculated for the Broca and Wernicke areas and correlated with language and cognitive outcomes measured by the Kaufman Assessment Battery for Children II ed. Language outcome in children with perinatal stroke is poorer compared to healthy controls. Children with small AIS lesions and most children with PVI showed left-side language activation. Most children with large AIS lesions and one child with large PVI had language activation reorganized to the right hemisphere. Language reorganization to the unlesioned right hemisphere did not ensure normal language outcome.
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Affiliation(s)
- Nigul Ilves
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia; Department of Radiology, University of Tartu, Tartu, Estonia.
| | - Mairi Männamaa
- Department of Pediatrics, University of Tartu, Tartu, Estonia; Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Rael Laugesaar
- Department of Pediatrics, University of Tartu, Tartu, Estonia; Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Norman Ilves
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia; Department of Radiology, University of Tartu, Tartu, Estonia
| | - Dagmar Loorits
- Department of Radiology, University of Tartu, Tartu, Estonia
| | - Ulvi Vaher
- Department of Radiology, University of Tartu, Tartu, Estonia; Department of Pediatrics, University of Tartu, Tartu, Estonia; Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Pille Kool
- Department of Radiology, University of Tartu, Tartu, Estonia
| | - Pilvi Ilves
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia; Department of Radiology, University of Tartu, Tartu, Estonia
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François C, Garcia-Alix A, Bosch L, Rodriguez-Fornells A. Signatures of brain plasticity supporting language recovery after perinatal arterial ischemic stroke. BRAIN AND LANGUAGE 2021; 212:104880. [PMID: 33220646 DOI: 10.1016/j.bandl.2020.104880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 09/11/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
Brain imaging methods such as functional Magnetic Resonance Imaging (fMRI) and Diffusion Tensor Imaging (DTI) have already been used to decipher the functional and structural brain changes occurring during normal language development. However, little is known about the differentiation of the language network after an early lesion. While in adults, stroke over the left hemisphere generally induces post-stroke aphasia, it is not always the case when a stroke occurs in the perinatal period, thus revealing a remarkable plastic power of the language network during early development. In particular, the role of perilesional tissues, as opposed to undamaged brain areas in the functional recovery of language functions after an early insult, remains unclear. In this review article, we provide an overview of the extant literature using functional and structural neuroimaging data revealing the signatures of brain plasticity underlying near-normal language development.
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Affiliation(s)
| | - Alfredo Garcia-Alix
- Service of Genetic and Molecular Medicine, Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; NeNe Foundation, Madrid, Spain
| | - Laura Bosch
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain; Institute of Neurosciences (UBNeuro), University of Barcelona, Barcelona, Spain
| | - Antoni Rodriguez-Fornells
- Cognition and Brain Plasticity Group, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain
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Carlson HL, Craig BT, Hilderley AJ, Hodge J, Rajashekar D, Mouches P, Forkert ND, Kirton A. Structural and functional connectivity of motor circuits after perinatal stroke: A machine learning study. Neuroimage Clin 2020; 28:102508. [PMID: 33395997 PMCID: PMC7704459 DOI: 10.1016/j.nicl.2020.102508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/19/2020] [Accepted: 11/15/2020] [Indexed: 11/15/2022]
Abstract
Developmental neuroplasticity allows young brains to adapt via experiences early in life and also to compensate after injury. Why certain individuals are more adaptable remains underexplored. Perinatal stroke is an ideal human model of neuroplasticity with focal lesions acquired near birth in a healthy brain. Machine learning can identify complex patterns in multi-dimensional datasets. We used machine learning to identify structural and functional connectivity biomarkers most predictive of motor function. Forty-nine children with perinatal stroke and 27 controls were studied. Functional connectivity was quantified by fluctuations in blood oxygen-level dependent (BOLD) signal between regions. White matter tractography of corticospinal tracts quantified structural connectivity. Motor function was assessed using validated bimanual and unimanual tests. RELIEFF feature selection and random forest regression models identified predictors of each motor outcome using neuroimaging and demographic features. Unilateral motor outcomes were predicted with highest accuracy (8/54 features r = 0.58, 11/54 features, r = 0.34) but bimanual function required more features (51/54 features, r = 0.38). Connectivity of both hemispheres had important roles as did cortical and subcortical regions. Lesion size, age at scan, and type of stroke were predictive but not highly ranked. Machine learning regression models may represent a powerful tool in identifying neuroimaging biomarkers associated with clinical motor function in perinatal stroke and may inform personalized targets for neuromodulation.
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Affiliation(s)
- Helen L Carlson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| | - Brandon T Craig
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Alicia J Hilderley
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jacquie Hodge
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Deepthi Rajashekar
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Pauline Mouches
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Nils D Forkert
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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