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For: Núñez C, Stephan-Otto C, Arca G, Agut T, Arnaez J, Cordeiro M, Benavente-Fernández I, Boronat N, Lubián-López SP, Valverde E, Hortigüela M, García-Alix A. Neonatal arterial stroke location is associated with outcome at 2 years: a voxel-based lesion-symptom mapping study. Arch Dis Child Fetal Neonatal Ed 2022;107:45-50. [PMID: 33990386 DOI: 10.1136/archdischild-2020-320400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 11/04/2022]

For:	Núñez C, Stephan-Otto C, Arca G, Agut T, Arnaez J, Cordeiro M, Benavente-Fernández I, Boronat N, Lubián-López SP, Valverde E, Hortigüela M, García-Alix A. Neonatal arterial stroke location is associated with outcome at 2 years: a voxel-based lesion-symptom mapping study. Arch Dis Child Fetal Neonatal Ed 2022;107:45-50. [PMID: 33990386 DOI: 10.1136/archdischild-2020-320400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 11/04/2022]

Number

Cited by Other Article(s)

Pabst L, Hoyt CR, Felling RJ, Smith AE, Harpster K, Pardo AC, Bridge JA, Jiang B, Gehred A, Lo W. Neuroimaging and Neurological Outcomes in Perinatal Arterial Ischemic Stroke: A Systematic Review and Meta-Analysis. Pediatr Neurol 2024;157:19-28. [PMID: 38848613 DOI: 10.1016/j.pediatrneurol.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/09/2024] [Accepted: 04/29/2024] [Indexed: 06/09/2024]

Mackay MT, Chen J, Shapiro J, Pastore-Wapp M, Slavova N, Grunt S, Stojanovski B, Steinlin M, Beare RJ, Yang JYM. Association of Acute Infarct Topography With Development of Cerebral Palsy and Neurologic Impairment in Neonates With Stroke. Neurology 2023;101:e1509-e1520. [PMID: 37591776 PMCID: PMC10585702 DOI: 10.1212/wnl.0000000000207705] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/09/2023] [Indexed: 08/19/2023] Open

Abstract

BACKGROUND AND OBJECTIVES

Research investigating neonatal arterial ischemic stroke (NAIS) outcomes have shown that combined cortical and basal ganglia infarction or involvement of the corticospinal tract predict cerebral palsy (CP). The research question was whether voxel-based lesion-symptom mapping (VLSM) on acute MRI can identify brain regions associated with CP and neurodevelopmental impairments in NAIS.

METHODS

Newborns were recruited from prospective Australian and Swiss pediatric stroke registries. CP diagnosis was based on clinical examination. Language and cognitive-behavioral impairments were assessed using the Pediatric Stroke Outcome Measure, dichotomized to good (0-0.5) or poor (≥1), at ≥18 months of age. Infarcts were manually segmented using diffusion-weighted imaging, registered to a neonatal-specific brain template. VLSM was conducted using MATLAB SPM12 toolbox. A general linear model was used to correlate lesion masks with motor, language, and cognitive-behavioral outcomes. Voxel-wise t-statistics were calculated, correcting for multiple comparisons using family-wise error (FWE) rate.

RESULTS

Eighty-five newborns met the inclusion criteria. Infarct lateralization was left hemisphere (62%), right (8%), and bilateral (30%). At a median age of 2.1 years (interquartile range 1.9-2.6), 33% developed CP and 42% had neurologic impairments. Fifty-four grey and white matter regions correlated with CP (t > 4.33; FWE < 0.05), including primary motor pathway regions, such as the precentral gyrus, and cerebral peduncle, and regions functionally connected to the primary motor pathway, such as the pallidum, and corpus callosum motor segment. No significant correlations were found for language or cognitive-behavioral outcomes.

DISCUSSION

CP after NAIS correlates with infarct regions directly involved in motor control and in functionally connected regions. Areas associated with language or cognitive-behavioral impairment are less clear.

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Affiliation(s)

Mark T Mackay From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland.
Jian Chen From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
Jesse Shapiro From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
Manuela Pastore-Wapp From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
Nedelina Slavova From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
Sebastian Grunt From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
Belinda Stojanovski From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
Maja Steinlin From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
Richard J Beare From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
Joseph Yuan-Mou Yang From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland

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Haffner D, Lo WD. Infarct Analysis to Explain Outcomes of Perinatal Stroke: Leveling the Mountain Voxel by Voxel. Neurology 2023;101:641-642. [PMID: 37591775 DOI: 10.1212/wnl.0000000000207776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 08/19/2023] Open

Vasilescu DI, Rosoga AM, Vasilescu S, Dragomir I, Dima V, Dan AM, Cirstoiu MM. SARS-CoV-2 Infection during Pregnancy Followed by Thalamic Neonatal Stroke-Case Report. CHILDREN (BASEL, SWITZERLAND) 2023;10:958. [PMID: 37371190 DOI: 10.3390/children10060958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023]

Early predictors of neurodevelopment after perinatal arterial ischemic stroke: a systematic review and meta-analysis. Pediatr Res 2022:10.1038/s41390-022-02433-w. [PMID: 36575364 DOI: 10.1038/s41390-022-02433-w] [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: 08/26/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/28/2022]

Abstract

BACKGROUND AND AIMS

Perinatal arterial ischemic stroke (PAIS) often has lifelong neurodevelopmental consequences. We aimed to review early predictors (<4 months of age) of long-term outcome.

METHODS

We carried out a systematic literature search (PubMed and Embase), and included articles describing term-born infants with PAIS that underwent a diagnostic procedure within four months of age, and had any reported outcome parameter ≥12 months of age. Two independent reviewers included studies and performed risk of bias analysis.

RESULTS

We included 41 articles reporting on 1395 infants, whereof 1255 (90%) infants underwent follow-up at a median of 4 years. A meta-analysis was performed for the development of cerebral palsy (n = 23 studies); the best predictor was the qualitative or quantitative assessment of the corticospinal tracts on MRI, followed by standardized motor assessments. For long-term cognitive functioning, bedside techniques including (a)EEG and NIRS might be valuable. Injury to the optic radiation on DTI correctly predicted visual field defects. No predictors could be identified for behavior, language, and post-neonatal epilepsy.

CONCLUSION

Corticospinal tract assessment on MRI and standardized motor assessments are best to predict cerebral palsy after PAIS. Future research should be focused on improving outcome prediction for non-motor outcomes.

IMPACT

We present a systematic review of early predictors for various long-term outcome categories after perinatal arterial ischemic stroke (PAIS), including a meta-analysis for the outcome unilateral spastic cerebral palsy. Corticospinal tract assessment on MRI and standardized motor assessments are best to predict cerebral palsy after PAIS, while bedside techniques such as (a)EEG and NIRS might improve cognitive outcome prediction. Future research should be focused on improving outcome prediction for non-motor outcomes.

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