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Bektaş Ö, Göktaş ÖA, Atasay B, Teber S. Investigating the Impact on Long-Term Outcomes and the Necessity of Hereditary Thrombophilia Screening in Presumed or Perinatal Arterial Ischemic Stroke. Clin Appl Thromb Hemost 2024; 30:10760296241231944. [PMID: 38327150 PMCID: PMC10851766 DOI: 10.1177/10760296241231944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
This study aimed to investigate the influence of prothrombotic risk factors on long-term outcomes of patients with perinatal arterial ischemic stroke. The study was conducted through an analysis of monitoring results that were regularly maintained for approximately 20 years at a tertiary stroke-monitoring center. The study assessed prothrombotic risk factors, radiological area of involvement, clinical presentation, treatments, clinical outcomes, and long-term outcomes of the 48 patients included in the study, with a mean monitoring time of 77.6 ± 45.7 months (range: 6-204). Our results showed that the presence of prothrombotic risk factors did not affect long-term outcomes. However, patients with middle cerebral artery infarction had the highest risk of developing cerebral palsy, whereas those with presumed stroke had the highest risk of developing epilepsy. This study suggests that prothrombotic risk factors should not be evaluated during the acute stage unless there is a strong suspicion of the patient's history, and prevention or early diagnosis of presumed stroke patients will positively impact their long-term prognosis.
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Affiliation(s)
- Ömer Bektaş
- Department of Pediatric Neurology, Ankara University Medical School, Ankara, Turkey
| | - Özben Akıncı Göktaş
- Department of Pediatric Neurology, Ankara University Medical School, Ankara, Turkey
| | - Begüm Atasay
- Department of Neonatology, Ankara University Medical School, Ankara, Turkey
| | - Serap Teber
- Department of Pediatric Neurology, Ankara University Medical School, Ankara, Turkey
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2
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Xia Q, Guo F, Hou X, Tang Z, Liu L. Perinatal Stroke in a Chinese Neonatal Center: Clinical Characteristics, Long-Term Outcomes, and Prognostic Factors. Pediatr Neurol 2023; 148:111-117. [PMID: 37703655 DOI: 10.1016/j.pediatrneurol.2023.08.024] [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: 11/15/2022] [Revised: 07/30/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Neonatal stroke manifests atypically and can potentially result in significant neurological sequelae in affected infants. Studies on long-term neurodevelopmental outcomes and prognostic factors are limited. We aimed to assess the clinical characteristics, long-term outcomes, and prognostic factors of perinatal stroke. METHODS Patients diagnosed with perinatal stroke were enrolled from 2009 to 2018. Clinical data including general information, clinical manifestations, and risk factors were collected and compared. Follow-up was performed for at least two years. Statistical analysis was performed using the chi-square test, t tests, and logistic regression analysis. RESULTS Sixty-nine cases were identified with an incidence of one of 2049 live births (51 boys and 18 girls). Twenty-seven patients (39%) experienced perinatal ischemic stroke (PIS) and 42 (61%) perinatal hemorrhagic stroke (PHS). In 48 cases (69%) onset involved acute symptomatic stroke (21 ischemic strokes and 27 hemorrhagic strokes). Seizures within 12 to 72 hours (20 cases, 29%) were the most common presentations. Most (57%) perinatal arterial ischemic strokes focused on the left middle cerebral artery. About 43% of PHS was diagnosed with temporal lobe hemorrhage, and 40% of patients exhibited multiple lesions of cerebral parenchymal hemorrhage. There was no association between adverse prognosis after perinatal stroke and different risk factors. During follow-up, six patients (10%) were dead and 22 patients (35%) experienced adverse neurodevelopmental outcomes. CONCLUSIONS More infants exhibited hemorrhagic stroke than ischemic stroke. Among infants with asymptomatic perinatal stroke, PHS was more common. The first symptom of perinatal stroke within 12 to 72 hours after birth is convulsions, with the left middle cerebral artery and the temporal lobe being the most common lesion sites for ischemic and hemorrhagic strokes, respectively. PIS was more likely to achieve adverse outcomes.
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Affiliation(s)
- Qianqian Xia
- Pediatric Department, Peking University First Hospital, Beijing, China
| | - Fa Guo
- Pediatric Department, Peking University First Hospital, Beijing, China
| | - Xinlin Hou
- Pediatric Department, Peking University First Hospital, Beijing, China
| | - Zezhong Tang
- Pediatric Department, Peking University First Hospital, Beijing, China
| | - Lili Liu
- Pediatric Department, Peking University First Hospital, Beijing, China.
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3
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He Y, Ying J, Tang J, Zhou R, Qu H, Qu Y, Mu D. Neonatal Arterial Ischaemic Stroke: Advances in Pathologic Neural Death, Diagnosis, Treatment, and Prognosis. Curr Neuropharmacol 2022; 20:2248-2266. [PMID: 35193484 PMCID: PMC9890291 DOI: 10.2174/1570159x20666220222144744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/04/2022] [Accepted: 02/18/2022] [Indexed: 12/29/2022] Open
Abstract
Neonatal arterial ischaemic stroke (NAIS) is caused by focal arterial occlusion and often leads to severe neurological sequelae. Neural deaths after NAIS mainly include necrosis, apoptosis, necroptosis, autophagy, ferroptosis, and pyroptosis. These neural deaths are mainly caused by upstream stimulations, including excitotoxicity, oxidative stress, inflammation, and death receptor pathways. The current clinical approaches to managing NAIS mainly focus on supportive treatments, including seizure control and anticoagulation. In recent years, research on the pathology, early diagnosis, and potential therapeutic targets of NAIS has progressed. In this review, we summarise the latest progress of research on the pathology, diagnosis, treatment, and prognosis of NAIS and highlight newly potential diagnostic and treatment approaches.
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Affiliation(s)
- Yang He
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Junjie Ying
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Ruixi Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Haibo Qu
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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Gordeeva OB, Vashakmadze ND, Karaseva MS, Babaykina MA, Zhurkova NV, Soloshenko MA, Kretova EV. Modern Aspects of Anticoagulation System Disorders Diagnosis in Children with Different Polymorphisms in Coagulation Genes. Initial Results. PEDIATRIC PHARMACOLOGY 2022. [DOI: 10.15690/pf.v19i4.2444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background. Hemostatic system pathology is topical and poorly studied issue in pediatrics. One of the main causes of coagulation pathway disorders associated with thrombotic events is abnormality in various parts of the hemostatic system. Vascular accidents are commonly caused by anticoagulation system factors deficiency. Conventionally, thrombosis is a common event in adult patients, and there is no adequate attention to disorders of primary physiological anticoagulants system in children. More often acquired anticoagulant proteins deficiency develops in presence of various pathological conditions, especially after the past infectious diseases. All these diseases (thrombophilia, trombotic events, cardiovascular pathology, nervous system diseases, genetic diseases) can occur separately and in association with each other, plus clinical picture of coagulation events may be similar. Objective. The aim of the study is to evaluate changes in the physiological anticoagulants system in children with different pathologies who have polymorphic variants in coagulation genes and who had new coronavirus infection. Methods. The study included 33 children who had severe coronavirus infection in family clusters and had severe chronic pathology potentially associated with disorders of the coagulation system (nervous system damage, hypertrophic cardiomyopathy, hereditary monogenic syndromes, hemato-mesenchymal dysplasia syndrome). All children underwent complete examination including clinical examination, laboratory, and instrumental diagnostics. Results. Preliminary study results indicate significant incidence of polymorphic variants in coagulation genes (one third of children with various diseases from the study). Some children had decreased activity of anticoagulation system glycoproteins (from 6% to 36%) that confirmed the topicality of the examination of anticoagulation system factors deficiency and the need for further dynamic follow-up, as well as revealing of trombophilia predictors in children in selected target groups. Study on revealing anticoagulation system disorders and mutations in coagulation genes will predict the risk of thrombotic disorders. Conclusion. The obtained results have confirmed the significant role of the ongoing study for comprehensive assessment of hemostatic system disorders in children. That will allow us to optimize the approach to diagnosis and personalize the management strategy for patients with different chronic pathologies and disorders of the natural anticoagulants system. The study is currently ongoing.
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Affiliation(s)
- Olga B. Gordeeva
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University
| | - Nato D. Vashakmadze
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University
| | - Maria S. Karaseva
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery
| | - Marina A. Babaykina
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery
| | - Natalia V. Zhurkova
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery
| | - Margarita A. Soloshenko
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery
| | - Elena V. Kretova
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery
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Abstract
Perinatal ischemic stroke is a common cause of lifelong disability.
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Affiliation(s)
- Nicholas V Stence
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 125, Aurora, CO 80045, USA.
| | - David M Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 125, Aurora, CO 80045, USA
| | - Ilana Neuberger
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 125, Aurora, CO 80045, USA
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Ilves N, Lõo S, Ilves N, Laugesaar R, Loorits D, Kool P, Talvik T, Ilves P. Ipsilesional volume loss of basal ganglia and thalamus is associated with poor hand function after ischemic perinatal stroke. BMC Neurol 2022; 22:23. [PMID: 35022000 PMCID: PMC8753896 DOI: 10.1186/s12883-022-02550-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Perinatal stroke (PS) is the leading cause of hemiparetic cerebral palsy (CP). Involvement of the corticospinal tract on neonatal magnetic resonance imaging (MRI) is predictive of motor outcome in patients with hemiparetic CP. However, early MRI is not available in patients with delayed presentation of PS and prediction of hemiparesis severity remains a challenge. AIMS To evaluate the volumes of the basal ganglia, amygdala, thalamus, and hippocampus following perinatal ischemic stroke in relation to hand motor function in children with a history of PS and to compare the volumes of subcortical structures in children with PS and in healthy controls. METHODS Term born PS children with arterial ischemic stroke (AIS) (n = 16) and with periventricular venous infarction (PVI) (n = 18) were recruited from the Estonian Pediatric Stroke Database. MRI was accuired during childhood (4-18 years) and the volumes of the basal ganglia, thalamus, amygdala and hippocampus were calculated. The results of stroke patients were compared to the results of 42 age- and sex-matched healthy controls. Affected hand function was evaluated by Assisting Hand Assessment (AHA) and classified by the Manual Ability Classification System (MACS). RESULTS Compared to the control group, children with AIS had smaller volumes of the ipsi- and contralesional thalami, ipsilesional globus pallidus, nucleus accumbens and hippocampus (p < 0.005). Affected hand function in children with AIS was correlated with smaller ipsilesional thalamus, putamen, globus pallidus, hippocampus, amygdala and contralesional amygdala (r > 0.5; p < 0.05) and larger volume of the contralesional putamen and hippocampus (r < - 0.5; p < 0.05). In children with PVI, size of the ipsilesional caudate nucleus, globus pallidus, thalamus (p ≤ 0.001) and hippocampus (p < 0.03) was smaller compared to controls. Smaller volume of the ipsi- and contralesional thalami and ipsilesional caudate nucleus was correlated with affected hand function (r > 0.55; p < 0.05) in children with PVI. CONCLUSIONS Smaller volume of ipsilesional thalamus was associated with poor affected hand function regardless of the perinatal stroke subtype. The pattern of correlation between hand function and volume differences in the other subcortical structures varied between children with PVI and AIS. Evaluation of subcortical structures is important in predicting motor outcome following perinatal stroke.
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Affiliation(s)
- Nigul Ilves
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia.
- Department of Radiology, University of Tartu, L. Puusepa 8, 51014, Tartu, Estonia.
| | - Silva Lõo
- Department of Pediatric Neurology, University of Helsinki; Helsinki University Hospital, Helsinki, Finland
- Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Norman Ilves
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Radiology, University of Tartu, L. Puusepa 8, 51014, Tartu, Estonia
| | - Rael Laugesaar
- Department of Pediatrics, University of Tartu, Tartu, Estonia
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Dagmar Loorits
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Pille Kool
- Department of Radiology, University of Tartu, L. Puusepa 8, 51014, Tartu, Estonia
| | - Tiina Talvik
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Pilvi Ilves
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Radiology, University of Tartu, L. Puusepa 8, 51014, Tartu, Estonia
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7
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Mukherjee D, Kalita D, Das D, Kumar T, Kundu R. Clinico-Epidemiological Profile, Etiology, and Imaging in Neonatal Stroke: An Observational Study from Eastern India. Neurol India 2021; 69:62-65. [PMID: 33642272 DOI: 10.4103/0028-3886.310081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim The aim of this study was to assess the clinico-epidemiological profile, etiology, and imaging findings in neonatal stroke (NS). Materials and Methods This was a retrospective, observational study on neonates presenting with stroke between August 2014 and July 2016 to a tertiary care hospital in eastern India. Results In all, 43 neonates were analyzed, with a male-to-female ratio of 2.3:1. About 88% babies were born at term and the rest were preterm. In 37%, the etiology of stroke was related to hypoxic injury, 21% had sepsis, and 35% had idiopathic causes. Seizures were the most common mode of presentation (62%) followed by poor feeding, abnormal tone, recurrent apnea, encephalopathy, and hemiparesis. There was an almost equal prevalence of ischemic stroke (53%) and hemorrhagic stroke (HS). Middle cerebral artery territory was the primary site of involvement in arterial ischemic stroke, and intra ventricular hemorrhage was the most common presentation of HS. Conclusion NS is an acute emergency with high morbidity and mortality. Magnetic resonance imaging helps in diagnosis and prognostication in the absence or paucity of focal neurological signs in neonates.
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Affiliation(s)
- Devdeep Mukherjee
- Department of Pediatric Medicine, Institute of Child Health, Kolkata, West Bengal, India
| | - Dolly Kalita
- Department of Pediatric Medicine, Institute of Child Health, Kolkata, West Bengal, India
| | - Dipankar Das
- Department of Radiology, Institute of Child Health, Kolkata, West Bengal, India
| | - Tarun Kumar
- Department of Pediatric Medicine, Institute of Child Health, Kolkata, West Bengal, India
| | - Ritabrata Kundu
- Department of Pediatric Medicine, Institute of Child Health, Kolkata, West Bengal, India
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8
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Roy B, Arbuckle S, Walker K, Morgan C, Galea C, Badawi N, Novak I. The Role of the Placenta in Perinatal Stroke: A Systematic Review. J Child Neurol 2020; 35:773-783. [PMID: 32516012 DOI: 10.1177/0883073820929214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CONTEXT Placental pathology may be an important missing link in the causal pathway of perinatal stroke. The study aim was to systematically review the literature regarding the role of the placenta in perinatal stroke. MEDLINE, Embase, Scopus, and Web of Science electronic databases were searched from 2000 to 2019. Studies were selected based on predefined criteria. To enable comparisons, placental abnormalities were coded using Redline's classification. RESULTS Ten studies met the inclusion criteria. Less than a quarter of stroke cases had placental pathology reported. Placental abnormalities were more common among children with perinatal stroke than in the control group. The most frequent placental abnormality was Redline's category 2 (thrombo-inflammatory process). CONCLUSIONS Placental abnormalities appear to be associated with perinatal stroke, supporting additional indirect evidence and biological plausibility of a causative role. However, the results should be interpreted cautiously considering the low frequency of placental examination and lack of uniformity in placental pathology reporting. CLINICAL TRIAL REGISTRATION PROSPERO Registration no: CRD42017081256.
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Affiliation(s)
- Bithi Roy
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,University of Notre Dame Australia, Sydney, New South Wales, Australia.,94740The Mater Hospital, Sydney, New South Wales, Australia
| | - Susan Arbuckle
- Department of Histopathology, 8538Sydney Children's Hospital Network, Westmead, Sydney, New South Wales, Australia
| | - Karen Walker
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, Westmead, Sydney, New South Wales, Australia.,211065The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Catherine Morgan
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,383637Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, New South Wales, Australia
| | - Claire Galea
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,383637Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, New South Wales, Australia
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, Westmead, Sydney, New South Wales, Australia.,383637Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, New South Wales, Australia
| | - Iona Novak
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,383637Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, New South Wales, Australia
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9
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Govaert P, Triulzi F, Dudink J. The developing brain by trimester. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:245-289. [PMID: 32736754 DOI: 10.1016/b978-0-444-64239-4.00014-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Transient anatomical entities play a role in the maturation of brain regions and early functional fetal networks. At the postmenstrual age of 7 weeks, major subdivisions of the brain are visible. At the end of the embryonic period, the cortical plate covers the neopallium. The choroid plexus develops in concert with it, and the dorsal thalamus covers about half the diencephalic third ventricle surface. In addition to the fourth ventricle neuroepithelium the rhombic lips are an active neuroepithelial production site. Early reciprocal connections between the thalamus and cortex are present. The corticospinal tract has reached the pyramidal decussation, and the arteries forming the mature circle of Willis are seen. Moreover, the superior sagittal sinus has formed, and at the rostral neuropore the massa commissuralis is growing. At the viable preterm age of around 24 weeks PMA, white matter tracts are in full development. Asymmetric progenitor division permits production of neurons, subventricular zone precursors, and glial cells. Myelin is present in the ventral spinal quadrant, cuneate fascicle, and spinal motor fibers. The neopallial mantle has been separated into transient layers (stratified transitional fields) between the neuroepithelium and the cortical plate. The subplate plays an important role in organizing the structuring of the cortical plate. Commissural tracts have shaped the corpus callosum, early primary gyri are present, and opercularization has started caudally, forming the lateral fissure. Thalamic and striatal nuclei have formed, although GABAergic neurons continue to migrate into the thalamus from the corpus gangliothalamicum. Near-term PMA cerebral sublobulation is active. Between 24 and 32 weeks, primary sulci develop. Myelin is present in the superior cerebellar peduncle, rubrospinal tract, and inferior olive. Germinal matrix disappears from the telencephalon, except for the GABAergic frontal cortical subventricular neuroepithelium.
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Affiliation(s)
- Paul Govaert
- Department of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Neonatology, ZNA Middelheim, Antwerp, Belgium; Department of Rehabilitation and Physical Therapy, Gent University Hospital, Gent, Belgium.
| | - Fabio Triulzi
- Department of Pediatric Neuroradiology, Università Degli Studi di Milano, Milan, Italy
| | - Jeroen Dudink
- Department of Neonatology, University Medical Center, Utrecht, The Netherlands
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10
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Abstract
Perinatal stroke is a heterogeneous syndrome resulting from brain injury of vascular origin that occurs between 20 weeks of gestation and 28 days of postnatal life. The incidence of perinatal stroke is estimated to be between 1:1600 and 1:3000 live births (approximately 2500 children per year in the United States), though its actual incidence is difficult to estimate because it is likely underdiagnosed. Perinatal arterial ischemic stroke (PAIS) accounts for approximately 70% of cases of perinatal stroke. Cerebral sinovenous thrombosis, while less common, also accounts for a large proportion of the morbidity and mortality seen with perinatal stroke. Hemorrhagic stroke leads to disruption of neurologic function due to intracerebral hemorrhage that is nontraumatic in origin. While most cases of PAIS fall into one of these three categories, other patterns of injury should also be considered perinatal stroke. In some cases, the etiology of PAIS is not known but is idiopathic. This chapter will review the classification, risk factors, pathogenesis, clinical presentation, management, and long-term sequelae of perinatal stroke.
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Affiliation(s)
- Emmett E Whitaker
- Department of Anesthesiology, University of Vermont Larner College of Medicine, Burlington, VT, United States; Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States.
| | - Marilyn J Cipolla
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States; Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States; Department of Pharmacology, University of Vermont Larner College of Medicine, Burlington, VT, United States
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11
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Abstract
Perinatal strokes are a diverse but specific group of focal cerebrovascular injuries that occur early in brain development and affect an estimated 5 million people worldwide. The objective of this review is to describe the epidemiology, clinical presentations, pathophysiology, outcomes, and management for the 6 subtypes of perinatal stroke. Some perinatal strokes are symptomatic in the first days of life, typically with seizures, including neonatal arterial ischemic stroke, neonatal hemorrhagic stroke, and cerebral sinovenous thrombosis. The remaining subtypes present in the first year of life or later, usually with motor asymmetry and include arterial presumed perinatal ischemic stroke, presumed perinatal hemorrhagic stroke, and in utero periventricular venous infarction. The consequences of these injuries include cerebral palsy, epilepsy, and cognitive and behavioral challenges, in addition to the psychosocial impact on families. While there have been significant advances in understanding mechanisms of both injury and recovery, there is still a great deal to learn regarding causation and the optimization of outcomes.
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Affiliation(s)
- Mary Dunbar
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada; Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada; Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada.
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12
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Suppiej A, Toffoli E, Festa I, Cervesi C, Cappellari A, Manara R, Magarotto M, Cainelli E. Perinatal carotid artery ischemic stroke: Report of two cases. J Neonatal Perinatal Med 2019; 12:479-485. [PMID: 31450516 DOI: 10.3233/npm-1816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The mechanisms of perinatal stroke are poorly understood but preclinical studies point to the crucial role of perinatal inflammation. Carotid artery occlusion represents a very rare and severe cause of perinatal stroke. We describe two cases diagnosed with extensive ischemic stroke due to carotid artery occlusion. In both cases, we demonstrated placental vasculopathy. High levels of C-reactive protein in mother and/or neonates suggested inflammatory mechanism as a potential trigger. Both cases underwent hypothermic treatment without complications because of initial diagnosis of perinatal asphyxia. The prognosis at the time of the last follow up was severe including cerebral palsy, epilepsy and cognitive impairment. Our cases contribute to the actual debate on pathogenic mechanisms and treatment options for this rare condition.
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Affiliation(s)
- A Suppiej
- Department of Medical Sciences, Pediatric Section, University of Ferrara, Ferrara, Italy.,Child Neurology and Clinical Neurophysiology, Pediatric University Hospital, Padua, Italy
| | - E Toffoli
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital, Padua, Italy
| | - I Festa
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital, Padua, Italy
| | - C Cervesi
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital, Padua, Italy
| | - A Cappellari
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital, Padua, Italy
| | - R Manara
- Department of Neurosciences, Neuroradiology Unit, University of Salerno, Salerno, Italy
| | - M Magarotto
- Neonatal Intensive Care Unit, Pediatric University Hospital, Padua, Italy
| | - E Cainelli
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital, Padua, Italy
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13
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Gano D, Ferriero DM. Focal Cerebral Infarction. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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14
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Kouri I, Mathews K, Joshi C. Facial Weakness and Ophthalmoplegia in a 4-Day-Old Infant. Semin Pediatr Neurol 2018; 26:63-66. [PMID: 29961523 DOI: 10.1016/j.spen.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We present a neonate with neurologic deficits recognized at 4 days of age. A male infant was born at term via emergency cesarian section due to failure to progress and fetal decelerations. He underwent therapeutic hypothermia for hypoxic ischemic encephalopathy. Upon completion of rewarming, he was noted to have left facial palsy, abduction deficit on the left eye past the midline, and nystagmus involving the right eye. Brain magnetic resonance imaging showed a pontine stroke, and computed tomography angiogram revealed basilar artery thrombosis. He was treated with enoxaparin for 3 months, followed by low-dose aspirin. The mechanism of the stroke remains unclear, and there is limited evidence to guide management.
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Affiliation(s)
- Ioanna Kouri
- Department of Pediatrics and Neurology, University of Iowa Stead Family Children's Hospital, Iowa City, IA.
| | - Katherine Mathews
- Department of Pediatrics and Neurology, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Charuta Joshi
- Department of Pediatrics and Neurology, University of Iowa Stead Family Children's Hospital, Iowa City, IA
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Abstract
Perinatal brain injury may lead to long-term morbidity and neurodevelopmental impairment. Improvements in perinatal care have resulted in the survival of more infants with perinatal brain injury. The effects of hypoxia-ischemia, inflammation, and infection during critical periods of development can lead to a common pathway of perinatal brain injury marked by neuronal excitotoxicity, cellular apoptosis, and microglial activation. Various interventions can prevent or improve the outcomes of different types of perinatal brain injury. The objective of this article is to review the mechanisms of perinatal brain injury, approaches to prevention, and outcomes among children with perinatal brain injury.
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Lee CC, Lin JJ, Lin KL, Lim WH, Hsu KH, Hsu JF, Fu RH, Chiang MC, Chu SM, Lien R. Clinical Manifestations, Outcomes, and Etiologies of Perinatal Stroke in Taiwan: Comparisons between Ischemic, and Hemorrhagic Stroke Based on 10-year Experience in A Single Institute. Pediatr Neonatol 2017; 58:270-277. [PMID: 28087259 DOI: 10.1016/j.pedneo.2016.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/02/2016] [Accepted: 07/08/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Perinatal stroke is a common cause of established neurological sequelae. Although several risk factors have been identified, many questions regarding causes and clinical outcomes remain unanswered. This study investigated the clinical manifestations and outcomes of perinatal stroke and identified its etiologies in Taiwan. METHODS We searched the reports of head magnetic resonance imaging and computed tomography performed between January 2003 and December 2012. The medical records of enrolled infants with perinatal stroke were also reviewed. RESULTS Thirty infants with perinatal stroke were identified; 10 infants had perinatal arterial ischemic stroke (PAIS) and 20 had perinatal hemorrhagic stroke (PHS). Neonatal seizure was the most common manifestation and presented in 40% of infants with PAIS and 50% of infants with PHS. All survivors with PAIS and 77% of the surviving infants with PHS developed neurological sequelae. Acute seizure manifestation was associated with poststroke epilepsy in infants with PHS but not in infants with PAIS (86% vs. 0%, p=0.005). PAIS was mostly caused by dysfunctional hemostasis (20%) and embolism (20%), whereas PHS was mostly attributable to birth asphyxia (30%). CONCLUSION Perinatal stroke is associated with high mortality and morbidity rates in infants. Clinically, it can be difficult to distinguish PAIS and PHS. One should keep a high level of suspicion, especially for PHS, if infants develop unexplained seizure, cyanosis, conscious change, anemia, and/or thrombocytopenia. A systematic diagnostic approach is helpful in identifying the etiologies of perinatal stroke.
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Affiliation(s)
- Chien-Chung Lee
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No. 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan, ROC
| | - Jainn-Jim Lin
- Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No. 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan, ROC
| | - Kuang-Lin Lin
- Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No. 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan, ROC
| | - Wai-Ho Lim
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No. 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan, ROC
| | - Kai-Hsiang Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No. 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan, ROC
| | - Jen-Fu Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No. 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan, ROC
| | - Ren-Huei Fu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No. 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan, ROC
| | - Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No. 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan, ROC
| | - Shih-Ming Chu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No. 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan, ROC
| | - Reyin Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No. 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan, ROC.
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17
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Fluss J, Garcia-Tarodo S, Granier M, Villega F, Ferey S, Husson B, Kossorotoff M, Muehlethaler V, Lebon S, Chabrier S. Perinatal arterial ischemic stroke related to carotid artery occlusion. Eur J Paediatr Neurol 2016; 20:639-48. [PMID: 27025300 DOI: 10.1016/j.ejpn.2016.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/02/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aetiology of perinatal arterial ischemic stroke remains speculative. It is however widely accepted that the aetiology is multifactorial, involving various maternal, placental, foetal and neonatal risk factors. A resulting thromboembolic process is hypothesized and the placenta identified as the most plausible source. An arteriopathy, as observed in a significant proportion of childhood ischemic stroke, is thought to be rare. METHODS We report here five cases of perinatal stroke that differ from the vast majority by documented carotid occlusion, and add eleven other similar cases from the literature. RESULTS In the majority, an intraluminal thrombus of placental origin is the most probable hypothesis, while in the remaining ones, one can reasonably presume a direct vessel wall injury related to a traumatic delivery, yet generally unproven by imaging. CONCLUSION We hypothesize that most of these cases share similar pathophysiology with the more common perinatal arterial ischemic stroke but differ by a persistent identified thrombus in the carotid artery at the time of first imaging, leading to a more severe and extended ischemic damage responsible for an adverse neurological outcome.
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Affiliation(s)
- Joel Fluss
- Pediatric Neurology Unit, Pediatric Subspecialities Service, Children's Hospital, Geneva University Hospitals, Switzerland.
| | - Stephanie Garcia-Tarodo
- Pediatric Neurology Unit, Pediatric Subspecialities Service, Children's Hospital, Geneva University Hospitals, Switzerland
| | - Michèle Granier
- Neonatal Unit, Sud-Francilien Hospital Centre, Corbeil, France
| | - Frédéric Villega
- Pediatric Neurology, Children's Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Solène Ferey
- Unit of Pediatric Radiology, Children's Hospital, Geneva University Hospitals, Switzerland
| | - Béatrice Husson
- French Centre for Pediatric Stroke and Pediatric Radiology, Bicêtre University Hospital Centre, Le Kremlin-Bicêtre, France
| | - Manoelle Kossorotoff
- French Centre for Pediatric Stroke, Pediatric Neurology Department, APHP-Necker-Enfants Malades, University Hospital, Paris, France
| | - Vincent Muehlethaler
- Neonatal Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Sebastien Lebon
- Pediatric Neurology Unit, Department of Pediatrics, Lausanne University Hospital, Switzerland
| | - Stéphane Chabrier
- French Centre for Pediatric Stroke, University Hospital Centre of Saint-Etienne, 42055 Saint-Etienne Cedex 2, France
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18
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Ecury-Goossen GM, van der Haer M, Smit LS, Feijen-Roon M, Lequin M, de Jonge RCJ, Govaert P, Dudink J. Neurodevelopmental outcome after neonatal perforator stroke. Dev Med Child Neurol 2016. [PMID: 26212612 DOI: 10.1111/dmcn.12857] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To assess outcome after neonatal perforator stroke in the largest cohort to date. METHOD Survivors from a cohort of children diagnosed with neonatal perforator stroke using cranial ultrasound or magnetic resonance imaging were eligible for inclusion. Recovery and Recurrence Questionnaire score, presence of cerebral palsy (CP), and crude outcome were assessed, specifically (1) the ability to walk independently, (2) participation in regular education, and (3) the presence of epilepsy. RESULTS Thirty-seven patients (20 males, 17 females) aged 3 to 14 years (mean age 8y) were included in the study: 14 with isolated single perforator stroke, four with multiple isolated perforator strokes, and 19 with additional brain injury. Out of 18 children with isolated perforator stroke(s), four had CP, one could not walk independently, and one developed epilepsy. The posterior limb of the internal capsule was involved in four out of 18 patients; three of these patients had CP. Of 19 children with additional brain injury, 11 had CP and three were not able to walk independently. Three out of nine children with concomitant cortical middle cerebral artery stroke developed epilepsy. INTERPRETATION Perforator stroke patterns can be of use in predicting long-term outcome and for guiding counselling and surveillance. Motor outcome was favourable in children with isolated perforator stroke(s), except when the posterior limb of the internal capsule was involved.
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Affiliation(s)
- Ginette M Ecury-Goossen
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marit van der Haer
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Liesbeth S Smit
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Neurology, Division of Pediatric Neurology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Monique Feijen-Roon
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Maarten Lequin
- Department of Radiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Rogier C J de Jonge
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Paul Govaert
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Pediatrics, Koningin Paola Children's Hospital, Antwerp, Belgium
| | - Jeroen Dudink
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Radiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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19
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Ruess L, Dent CM, Tiarks HJ, Yoshida MA, Rusin JA. Neonatal deep white matter venous infarction and liquefaction: a pseudo-abscess lesion. Pediatr Radiol 2014; 44:1393-402. [PMID: 25304462 DOI: 10.1007/s00247-014-3006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/05/2014] [Accepted: 04/15/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Deep white matter hemorrhagic venous infarction with subsequent cavitation due to necrosis and liquefaction has been described in neonates and may be associated with infection and meningitis. In our experience, the MRI pattern of these lesions is confused with the pattern seen with cerebral abscesses. OBJECTIVE The purpose of our study was to characterize the MRI findings of post infarction necrosis and liquefaction after hemorrhagic deep white matter venous infarction in infants and to distinguish these lesions from cerebral abscesses. MATERIALS AND METHODS An institutional review board approved a retrospective review of imaging records to identify all patients with cerebral venous infarction at a children's hospital during a 10-year period. Nine infants had deep white matter hemorrhagic venous infarction with white matter fluid signal cavitary lesions. A diagnosis of cerebral abscess was considered in all. The imaging and laboratory findings in these patients are reviewed and compared to descriptions of abscesses found in the literature. RESULTS There were six female and three male infants. The mean age at presentation was 20 days (range: 0-90 days), while the corrected age at presentation was less than 30 days for all patients. Seven patients presented with seizures and signs of infection; one infant presented with lethargy and later proved to have protein C deficiency. MRI was performed 0-12 days from presentation in these eight patients. Another patient with known protein C deficiency underwent MRI at 30 days for follow-up of screening US abnormalities. There were a total of 38 deep cerebral white matter fluid signal cavitary lesions: 25 frontal, 9 parietal, 2 temporal, 2 occipital. Larger lesions had dependent debris. All lesions had associated hemorrhage and many lesions had evidence of adjacent small vessel venous thrombosis. Lesions imaged after gadolinium showed peripheral enhancement. Three lesions increased in size on follow-up imaging. Three patients, two with meningitis confirmed via microbiology and one with presumed meningitis by CSF counts, underwent surgical aspiration of a total of six lesions. All specimens were sent for pathology and culture and were negative for microorganisms. CONCLUSION Recognizing the MR appearance of cavitary necrosis and liquefaction after deep white matter cerebral venous infarction in neonates can distinguish this entity from cerebral abscess and potentially avoid an unnecessary neurosurgical aspiration procedure.
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Affiliation(s)
- Lynne Ruess
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA,
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20
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Extensive unilateral cerebral infarct in a full-term newborn. Indian J Pediatr 2013; 80:1056-8. [PMID: 23381916 DOI: 10.1007/s12098-013-0983-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
Abstract
The authors report a case of extensive, unilateral hemispheric infarct with internal carotid artery (ICA) occlusion in a term infant emphasizing the value of MRI, particularly diffusion weighted imaging (DWI).
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21
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Raets MMA, Sol JJ, Govaert P, Lequin MH, Reiss IKM, Kroon AA, Appel IM, Dudink J. Serial Cranial US for Detection of Cerebral Sinovenous Thrombosis in Preterm Infants. Radiology 2013. [DOI: 10.1148/radiology.13130401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Raets MMA, Sol JJ, Govaert P, Lequin MH, Reiss IKM, Kroon AA, Appel IM, Dudink J. Serial cranial US for detection of cerebral sinovenous thrombosis in preterm infants. Radiology 2013; 269:879-86. [PMID: 23985276 DOI: 10.1148/radiol.13130401] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To report the incidence of cerebral sinovenous thrombosis (CSVT) in a prospective cohort of preterm infants with a gestational age of less than 29 weeks. MATERIALS AND METHODS The local medical ethics review board approved this study, and written parental consent was obtained. Preterm infants with a gestational age of less than 29 weeks who were admitted to the neonatal intensive care unit were prospectively studied with cranial ultrasonography (US). The scanning protocol included visualization with color Doppler imaging of the superior sagittal sinus and transverse sinuses through the anterior (8.5-MHz probe) and mastoid (13-MHz probe) fontanelles. When feasible, magnetic resonance imaging was performed to confirm cranial US-diagnosed CSVT. The differences between preterm infants with and those without CSVT were analyzed by using Mann-Whitney tests for continuous variables and Fisher exact tests for categorical data. RESULTS Cranial US was used to document CSVT in 11 of 249 preterm infants with a gestational age of less than 29 weeks. Transverse sinuses were most frequently affected (in all 11 patients with CSVT). All infants with CSVT were asymptomatic. Postnatal age at diagnosis ranged from 5 to 34 days. The mean gestational age was significantly lower in infants with CSVT (25.9 weeks vs 26.8 weeks, P = .038). Of the risk factors studied, only duration of mechanical ventilation was associated with CSVT; it was significantly longer in the CSVT group. CONCLUSION Systematic serial cranial US of infants with a gestational age of less than 29 weeks showed a remarkably high incidence of CSVT of 4.4%. Cranial US including color Doppler imaging with scans obtained through the mastoid fontanelle can depict CSVT at an early stage. Treatment of this possibly important condition needs attention.
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Affiliation(s)
- Marlou M A Raets
- From the Departments of Neonatology (M.M.A.R., J.J.S., P.G., I.K.M.R., A.A.K., J.D.), Pediatric Radiology (M.H.L., J.D.), and Hematology (I.M.A.), Erasmus MC-Sophia Children's Hospital Rotterdam, Dr Molewaterplein 60, 3015 GJ Rotterdam, the Netherlands; and Department of Pediatrics, Koningin Paola Children's Hospital, Antwerp, Belgium (P.G.)
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23
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Sannia A, Natalizia AR, Parodi A, Malova M, Fumagalli M, Rossi A, Ramenghi LA. Different gestational ages and changing vulnerability of the premature brain. J Matern Fetal Neonatal Med 2013; 28 Suppl 1:2268-72. [PMID: 23968292 DOI: 10.3109/14767058.2013.796166] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In recent decades, there has been a general increase in survival rates of preterm and low birth weight infants, but this overall decrease in perinatal mortality has not been accompanied by a decrease in long-term physical and mental disability. In order to reduce the long-term sequelae of prematurity and to establish preventive measures, it is important to identify risk factors since the main determinant of specific vulnerability to different types of lesions is gestational age. The regional tissue vulnerability at a given gestational age is probably determined by the local metabolic requirements together with specific cell characteristics and their level of maturation. In this article, we discuss the most common neonatal cerebral lesions (cerebellar haemorrhage, germinal matrix intraventricular haemorrhage, periventricular leukomalacia, arterial ischaemic stroke, cerebral vein sinus thrombosis and hypoxic-ischaemic encephalopathy) related to the gestational age-dependent vulnerability of the premature brain.
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Affiliation(s)
- Andrea Sannia
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Anna R Natalizia
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Alessandro Parodi
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Mariya Malova
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Monica Fumagalli
- b NICU, Department of Clinical Sciences and Community Health , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano , Milan , Italy , and
| | - Andrea Rossi
- c Pediatric Neuroradiology Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Luca A Ramenghi
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
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Ecury-Goossen GM, Raets MMA, Lequin M, Feijen-Roon M, Govaert P, Dudink J. Risk Factors, Clinical Presentation, and Neuroimaging Findings of Neonatal Perforator Stroke. Stroke 2013; 44:2115-20. [DOI: 10.1161/strokeaha.113.001064] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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van der Aa NE, Dudink J, Benders MJNL, Govaert P, van Straaten HLM, Porro GL, Groenendaal F, de Vries LS. Neonatal posterior cerebral artery stroke: clinical presentation, MRI findings, and outcome. Dev Med Child Neurol 2013; 55:283-90. [PMID: 23336217 DOI: 10.1111/dmcn.12055] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2012] [Indexed: 12/25/2022]
Abstract
AIM To report the clinical presentation, magnetic resonance imaging (MRI) findings, and follow-up data of newborn infants with perinatal arterial ischemic stroke in the territory of the posterior cerebral artery (PCA). METHOD Data on 18 newborn infants from three neonatal intensive care units (11 males, seven females) with an MRI-confirmed PCA stroke were analysed and reported. Infants were born at a mean gestational age of 38.7 weeks (SD 3.4) with a mean birthweight of 3244g (SD 850). RESULTS Fourteen infants presented with clinical seizures. Five of these had associated hypoxic-ischemic encephalopathy, four had hypoglycaemia, and five had neither hypoxic-ischemic encephalopathy nor hypoglycaemia. Subclinical seizures were present in one infant with hypoxic-ischemic encephalopathy and one with meningitis. One preterm infant presented with apnoeas and one had hypoxic-ischemic encephalopathy without seizures. Neurodevelopmental follow-up of 17 children at a median age of 36 months (SD 28, range 12-120mo) showed five with a global delay. Two children with additional injury developed postneonatal epilepsy and one child with extensive injury developed hemiplegia. A visual field defect was observed in nine children (six hemianopia, three quadrantanopia). In the 11 children with a second MRI at 3 months, the asymmetry of the optic radiation correlated with the development of a visual field deficit. INTERPRETATION Outcome after PCA stroke is fairly good, depending on additional brain injury. Follow-up is required, as subsequent visual field defects are frequently observed. Further research will be needed to clarify the role of hypoglycaemia in perinatal arterial ischemic stroke.
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Affiliation(s)
- Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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26
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Scher MS. Normal and abnormal cerebrovascular development. HANDBOOK OF CLINICAL NEUROLOGY 2013; 112:1021-42. [DOI: 10.1016/b978-0-444-52910-7.00021-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Scher MS. Developmental origins of cerebrovascular disease II: considering gene-environment interactions when developing neuroprotective strategies. J Child Neurol 2012; 27:238-50. [PMID: 22180566 DOI: 10.1177/0883073811417715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The second part of this review of the developmental origins of cerebrovascular disease discusses prenatal gene-environment interactions concerning maternal, placental, and fetal conditions that culminate in specific injuries such as perinatal stroke, as well as complications of intrauterine growth restriction and congenital heart disease. A greater understanding of gene-environment influences on cerebrovascular health and disease in early life will contribute to the successful development of neuroprotective strategies throughout the lifespan.
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Affiliation(s)
- Mark S Scher
- School of Medicine, Case Western Reserve University, and Division of Pediatric Neurology, Fetal/Neonatal Neurology Program, Rainbow Babies and Children's Hospital, Case Medical Center, University Hospitals of Cleveland, OH, USA.
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Wintermark P, Warfield SK. New insights in perinatal arterial ischemic stroke by assessing brain perfusion. Transl Stroke Res 2011; 3:255-62. [PMID: 24323781 DOI: 10.1007/s12975-011-0122-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 10/17/2011] [Accepted: 10/20/2011] [Indexed: 10/15/2022]
Abstract
Perinatal arterial ischemic stroke (AIS) is an important cause of long-term morbidity in children. Thus, there is an urgent need to better understand the mechanisms of stroke in newborns in order to develop effective treatment and prevention strategies. The purpose of this study was to assess brain perfusion within the first month of life in newborns with AIS. In this study, magnetic resonance imaging (MRI) and perfusion imaging by arterial spin labeling (ASL) were used to assess brain perfusion in four term newborns with AIS. One patient had a stroke within the territory of the right middle cerebral artery (MCA); the other three patients had a stroke within the territory of the left MCA. None of them displayed any hemorrhagic component. All four patients demonstrated abnormal brain perfusion in the stroke area. Cerebral blood flow (CBF) within the stroke area was increased in patient # 1. In all other three patients, CBF was decreased within the stroke center and increased in the periphery of the stroke area. These results show the feasibility of the ASL sequence in newborns with AIS and support its addition to the current MRI protocol used in these newborns as it provides useful information on brain hemodynamics. Its value for identifying salvageable tissue in newborns needs to be further assessed, as well as its potential role in stroke follow-up and for tissue-specific treatment screening.
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Affiliation(s)
- Pia Wintermark
- Division of Newborn Medicine, Montreal Children's Hospital, McGill University, 2300 rue Tupper, C-920, Montreal, QC, H3H 1P3, Canada,
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Abstract
An improved understanding of perinatal stroke epidemiology, classification, neuroimaging, and outcomes has emerged in recent years. Despite this, little is known regarding the pathophysiological mechanisms responsible for most cases. A multitude of possible associations and putative risk factors have been reported, but most lack definitive empirical evidence supporting primary causation. These include obstetrical and maternal factors, perinatal conditions, infectious diseases, prothrombotic abnormalities, cardiac disorders, medications, and many others. The bulk of evidence is weak, dominated by case reports and retrospective case series. Findings from the small number of case-control and cohort studies that exist are limited by heterogeneous populations and methodologies. The single largest barrier to ultimately understanding and potentially improving outcomes from this common and disabling condition is the lack of comprehensive, fully powered risk factor studies required to definitively describe perinatal stroke pathogenesis. This review summarizes current evidence and suggests future directions for research.
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Affiliation(s)
- Aleksandra Mineyko
- The Division of Neurology, Department of Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Adam Kirton
- The Division of Neurology, Department of Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada
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