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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] [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]
Abstract
BACKGROUND Prediction of outcomes in perinatal arterial ischemic stroke (PAIS) is challenging. We performed a systematic review and meta-analysis to determine whether infarct characteristics can predict outcomes in PAIS. METHODS A systematic search was conducted using five databases in January 2023. Studies were included if the sample included children with neonatal or presumed PAIS; if infarct size, location, or laterality was indicated; and if at least one motor, cognitive, or language outcome was reported. The level of evidence and risk of bias were evaluated using the Risk of Bias in Non-Randomized Studies of Interventions tool. Meta-analyses were conducted comparing infarct size or location with neurological outcomes when at least three studies could be analyzed. RESULTS Eighteen full-text articles were included in a systematic review with nine included in meta-analysis. Meta-analyses revealed that small strokes were associated with a lower risk of cerebral palsy/hemiplegia compared with large strokes (risk ratio [RR] = 0.263, P = 0.001) and a lower risk of epilepsy (RR = 0.182, P < 0.001). Middle cerebral artery (MCA) infarcts were not associated with a significantly different risk of cerebral palsy/hemiplegia compared with non-MCA strokes (RR = 1.220, P = 0.337). Bilateral infarcts were associated with a 48% risk of cerebral palsy/hemiplegia, a 26% risk of epilepsy, and a 58% risk of cognitive impairment. CONCLUSIONS Larger stroke size was associated with worse outcomes across multiple domains. Widely heterogeneous reporting of infarct characteristics and outcomes limits the comparison of studies and the analysis of outcomes. More consistent reporting of infarct characteristics and outcomes will be important to advance research in this field.
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Affiliation(s)
- Lisa Pabst
- Division of Neurology, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
| | - Catherine R Hoyt
- Program in Occupational Therapy, Department of Neurology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan J Felling
- Department of Neurology & Kennedy Krieger Institute, Johns Hopkins Medicine, Baltimore, Maryland
| | - Alyssa E Smith
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Andrea C Pardo
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey A Bridge
- Departments of Pediatrics and Psychiatry & Behavioral Health, Nationwide Children's Hospital and The Ohio State University College of Medicine, Center for Suicide Prevention and Research, Columbus, Ohio
| | - Bin Jiang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Stanford, California
| | - Alison Gehred
- Nationwide Children's Hospital Library, Columbus, Ohio
| | - Warren Lo
- Division of Neurology, Nationwide Children's Hospital, Columbus, Ohio
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Bhagat I, Sarkar R, Bapuraj JR, Sarkar S. Routine Echocardiography is not Required in Neonates with Arterial Ischemic Stroke. Am J Perinatol 2024; 41:e1-e5. [PMID: 38171384 DOI: 10.1055/a-2237-8711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Current guidelines suggest routine echocardiography (ECHO) in the acute phase to exclude a cardiac source for neonatal arterial ischemic stroke (NAIS). However, the commonly assumed embolic origin from a cardiac source for NAIS is challenged and the need for ECHO in NAIS remains questionable, especially during the era of standard fetal anomaly scanning. Our hypothesis is that any complex cardiac defects potentially causing NAIS would likely be detected during routine prenatal scans, thus possibly making routine postnatal ECHO redundant. This study aimed to determine the prevalence of significant cardiac risk factors and evaluate the necessity of routine postnatal ECHO in NAIS during the routine use of prenatal fetal sonography. STUDY DESIGN Retrospective review of 54 infants diagnosed with NAIS via brain magnetic resonance imaging who underwent an ECHO evaluation during the acute period to exclude potential cardiac origins for NAIS. RESULTS Postnatal ECHO revealed no intracardiac thrombus or vegetation, and only identified structural heart anomalies in three (5%) infants. Interestingly, these three cases had already been diagnosed with syndromic conditions or chromosomal malformations prenatally. In the remaining infants, postnatal ECHO was either normal or showed minor abnormalities unlikely to have contributed to the stroke. The detection rates of complex cardiac anomalies from prenatal scans and postnatal ECHO were statistically similar (p = 0.617). CONCLUSION The probability of ECHO to exclude cardiac sources for NAIS is so low that in the era of standard fetal anomaly scanning, routine postnatal ECHO may not be necessary for all NAIS infants, except when chromosomal malformations are detected. KEY POINTS · Guidelines recommend an acute phase ECHO to identify a cardiac source of NAIS.. · ECHO not effective at excluding NAIS's cardiac origin for infants with normal fetal scans.. · Routine postnatal ECHO is unnecessary in NAIS infants, except with genetic abnormalities..
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Affiliation(s)
- Indira Bhagat
- Division of Neonatal-Perinatal Medicine, Central Michigan University, Mount Pleasant, Michigan
| | - Rohan Sarkar
- Research Volunteer, Michigan State University, East Lansing, Michigan
| | | | - Subrata Sarkar
- Division of Neonatal-Perinatal Medicine, University of Michigan, Ann Arbor, Michigan
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Lammert DB, Miller JL, Atkinson MA, Sun LR. Single-center Incidence and Patterns of Stroke in Early Renal Anhydramnios after Serial Amnioinfusions. J Pediatr 2024:114053. [PMID: 38615944 DOI: 10.1016/j.jpeds.2024.114053] [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: 01/26/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
The Renal Anhydramnios Fetal Therapy (RAFT) trial is a study of serial amnioinfusions to prevent lethal neonatal pulmonary hypoplasia from early renal anhydramnios. Infant neurologic outcomes were not originally evaluated. We describe the high incidence of stroke observed among infants in the treatment arm of the trial at our center.
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Affiliation(s)
- Dawn B Lammert
- Johns Hopkins School of Medicine, Department of Neurology, Division of Child Neurology, Baltimore, Maryland;.
| | - Jena L Miller
- Johns Hopkins School of Medicine, Department of Obstetrics and Gynecology, Johns Hopkins Center for Fetal Therapy, Baltimore, MD
| | - Meredith A Atkinson
- Johns Hopkins School of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Baltimore, MD
| | - Lisa R Sun
- Johns Hopkins School of Medicine, Department of Neurology, Division of Child Neurology, Baltimore, Maryland
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4
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Fortune A, Perkins E, Paize F, Palanisami B, Gladstone M. Managing mothers' and fathers' uncertainty during their journey through early neurodevelopmental follow-up for their high-risk infants-A qualitative account. Child Care Health Dev 2024; 50:e13168. [PMID: 37737651 DOI: 10.1111/cch.13168] [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: 06/27/2022] [Revised: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Early diagnosis of cerebral palsy is possible by 5 months corrected age for 'at-risk' infants, using diagnostic tools such as the Hammersmith Infant Neurological Examination (HINE), Prechtl's General Movements Assessment (GMA) and magnetic resonance imaging (MRI). This is an uncertain and stressful time for parents where provision of appropriate information and support is essential. AIM To explore parents' views and experiences in relation to the new early neurodevelopmental follow-up of 'at-risk' infants. METHODS Thirteen in-depth one-to-one qualitative interviews were conducted by the primary researcher, with eight parents (six mothers and two fathers) of 'at-risk' infants eligible for a follow-up clinic where the GMA and HINE were performed at 12-week corrected age. Interviews used a pre-piloted topic guide and took place before and after the clinic. Interviews were audio-recorded, transcribed verbatim and analysed using inductive coding and thematic analysis using the framework approach. FINDINGS Seven themes were identified: (1) attempting to manage uncertainty, (2) taking priority, (3) trusting professionals, (4) independence in the parent role, (5) feeling understood, (6) patterns of care and (7) individuality. Parents reported experiencing uncertainty about their current situation and future. Adequate preparation for and timing of information are vital. When uncertainty is poorly managed, parents' wellbeing suffers. Individual parents' perspectives and infants' developmental trajectories differ, and information should be tailored specifically for this. CONCLUSION A parent's understanding of the journey through neurodevelopmental care for their high risk infants is initially very limited. Implementing a counselling service for parents to access psychological support and digital reminder system for clinic appointments, as well as providing more tailored information through trusted professionals, could all improve future parents' experiences.
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Affiliation(s)
- Alice Fortune
- Department Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Elizabeth Perkins
- Department of Primary Care and Mental Health, Institute of Population Health, Liverpool, UK
| | - Fauzia Paize
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | | | - Melissa Gladstone
- Department Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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Bruschettini M, Badura A, Romantsik O. Stem cell-based interventions for the treatment of stroke in newborn infants. Cochrane Database Syst Rev 2023; 11:CD015582. [PMID: 37994736 PMCID: PMC10666199 DOI: 10.1002/14651858.cd015582.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Perinatal stroke refers to a diverse but specific group of cerebrovascular diseases that occur between 20 weeks of fetal life and 28 days of postnatal life. Acute treatment options for perinatal stroke are limited supportive care, such as controlling hypoglycemia and seizures. Stem cell-based therapies offer a potential therapeutic approach to repair, restore, or regenerate injured brain tissue. Preclinical findings have culminated in ongoing human neonatal studies. OBJECTIVES To evaluate the benefits and harms of stem cell-based interventions for the treatment of stroke in newborn infants compared to control (placebo or no treatment) or stem-cell based interventions of a different type or source. SEARCH METHODS We searched CENTRAL, PubMed, Embase, and three trials registries in February 2023. We planned to search the reference lists of included studies and relevant systematic reviews for studies not identified by the database searches. SELECTION CRITERIA We attempted to include randomized controlled trials, quasi-randomized controlled trials, and cluster trials that evaluated any of the following comparisons. • Stem cell-based interventions (any type) versus control (placebo or no treatment) • Mesenchymal stem/stromal cells (MSCs) of a specifictype (e.g. number of doses or passages) or source (e.g. autologous/allogeneic or bone marrow/cord) versus MSCs of another type or source • Stem cell-based interventions (other than MSCs) of a specific type (e.g. mononuclear cells, oligodendrocyte progenitor cells, neural stem cells, hematopoietic stem cells, or induced pluripotent stem cell-derived cells) or source (e.g. autologous/allogeneic or bone marrow/cord) versus stem cell-based interventions (other than MSCs) of another type or source • MSCs versus stem cell-based interventions other than MSCs We planned to include all types of transplantation regardless of cell source (bone marrow, cord blood, Wharton's jelly, placenta, adipose tissue, peripheral blood), type of graft (autologous or allogeneic), and dose. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were all-cause neonatal mortality, major neurodevelopmental disability, and immune rejection or any serious adverse event. Our secondary outcomes included all-cause mortality prior to first hospital discharge, seizures, adverse effects, and death or major neurodevelopmental disability at 18 to 24 months of age. We planned to use GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We identified no completed or ongoing randomized trials that met our inclusion criteria. We excluded three studies: two were phase 1 trials, and one included newborn infants with conditions other than stroke (i.e. cerebral ischemia and anemia). Among the three excluded studies, we identified the first phase 1 trial on the use of stem cells for neonatal stroke. It reported that a single intranasal application of bone marrow-derived MSCs in term neonates with a diagnosis of perinatal arterial ischemic stroke (PAIS) was feasible and apparently not associated with severe adverse events. However, the trial included only 10 infants, and follow-up was limited to three months. AUTHORS' CONCLUSIONS No evidence is currently available to evaluate the benefits and harms of stem cell-based interventions for treatment of stroke in newborn infants. We identified no ongoing studies. Future clinical trials should focus on standardizing the timing and method of cell delivery and cell processing to optimize the therapeutic potential of stem cell-based interventions and safety profiles. Phase 1 and large animal studies might provide the groundwork for future randomized trials. Outcome measures should include all-cause mortality, major neurodevelopmental disability and immune rejection, and any other serious adverse events.
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Affiliation(s)
- Matteo Bruschettini
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anna Badura
- Department of Neonatology, University Children's Hospital Regensburg, Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany
| | - Olga Romantsik
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Bruschettini M, Badura A, Romantsik O. Stem cell‐based interventions for the treatment of stroke in newborn infants. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2023; 2023:CD015582. [PMCID: PMC9933426 DOI: 10.1002/14651858.cd015582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of stem cell‐based interventions for the treatment of stroke in newborn infants compared to control (placebo or no treatment) or stem‐cell based interventions of a different type or source.
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Affiliation(s)
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, PaediatricsLund University, Skåne University HospitalLundSweden,Cochrane SwedenLund University, Skåne University HospitalLundSweden
| | | | - Olga Romantsik
- Department of Clinical Sciences Lund, PaediatricsLund University, Skåne University HospitalLundSweden
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7
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Tan H, Gong Z, Xing S, Cao L, Liu H, Xu L. Effects of balance training in addition to auxiliary activity on balance function of patients with stroke at high risk for falls. Front Neurol 2023; 13:937305. [PMID: 36686536 PMCID: PMC9849380 DOI: 10.3389/fneur.2022.937305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/21/2022] [Indexed: 01/06/2023] Open
Abstract
Objective The aim of this study was to investigate the effect of balance training in addition to auxiliary activity on the balance function of patients with stroke at high risk for falls. Methods A total of 112 patients with stroke at high risk for falls in our hospital from inception to January 2020 to December 2020 were selected as the research objects who were equally divided into the control group and study group according to the random number table method. Patients in the control group were intervened with auxiliary activity, and the patients in the study group received additional balance training for auxiliary activity. The balance function, lower extremity motor function, fall risk, walking ability, and other indicators were compared between the two groups of patients before and after treatment. The hospitalization time and the frequency of falls 3 months after discharge were also compared between the two groups. Results Before treatment, there was no significant difference in balance function, lower extremity motor function, fall risk, and walking ability scores between the two groups (P > 0.05). After 3 months of treatment, the balance function, lower extremity motor function, and walking ability scores of the study group were significantly higher than those of the control group, with the fall risk score significantly lower than that of the control group (P < 0.05). Evidently, lower hospitalization time and the frequency of falls in the 3-month follow-up of the study group were observed than those in the control group (P < 0.05). However, there was no significant difference in the frequency of falls between the two groups during hospitalization (P > 0.05). Conclusion Our results indeed revealed that balance training in addition to auxiliary activity elicited beneficial outcomes in terms of effectively improving the balance function and walking ability of patients with stroke at high risk of falling, which may have the potential for wide clinical application.
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Affiliation(s)
- Huiqun Tan
- Department of General Practice, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China,Hubei Key Laboratory of Kidney Disease Pathogenesis and Intervention, Huangshi, China
| | - Zhaohui Gong
- Hubei Key Laboratory of Kidney Disease Pathogenesis and Intervention, Huangshi, China,Department of Geriatrics, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China
| | - Sisi Xing
- Hubei Key Laboratory of Kidney Disease Pathogenesis and Intervention, Huangshi, China,Department of Neurology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China
| | - Lanhua Cao
- Hubei Key Laboratory of Kidney Disease Pathogenesis and Intervention, Huangshi, China,Department of Spine Surgery, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China,*Correspondence: Lanhua Cao
| | - Huan Liu
- Hubei Key Laboratory of Kidney Disease Pathogenesis and Intervention, Huangshi, China,Department of Neurosurgery, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China,Huan Liu
| | - Lijun Xu
- Hubei Key Laboratory of Kidney Disease Pathogenesis and Intervention, Huangshi, China,Department of Radiology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China,Lijun Xu
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8
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Srivastava R, Mailo J, Dunbar M. Perinatal Stroke in Fetuses, Preterm and Term Infants. Semin Pediatr Neurol 2022; 43:100988. [PMID: 36344024 DOI: 10.1016/j.spen.2022.100988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/06/2022] [Accepted: 07/29/2022] [Indexed: 12/14/2022]
Abstract
Perinatal stroke is a well-defined heterogenous group of disorders involving a focal disruption of cerebral blood flow between 20 weeks gestation and 28 days of postnatal life. The most focused lifetime risk for stroke occurs during the first week after birth. The morbidity of perinatal stroke is high, as it is the most common cause of hemiparetic cerebral palsy which results in lifelong disability that becomes more apparent throughout childhood. Perinatal strokes can be classified by the timing of diagnosis (acute or retrospective), vessel involved (arterial or venous), and underlying cause (hemorrhagic or ischemic). Perinatal stroke has primarily been reported as a disorder of term infants; however, the preterm brain possesses different vulnerabilities that predispose an infant to stroke injury both in utero and after birth. Accurate diagnosis of perinatal stroke syndromes has important implications for investigations, management, and prognosis. The classification of perinatal stroke by age at presentation (fetal, preterm neonatal, term neonatal, and infancy/childhood) is summarized in this review, and includes detailed descriptions of risk factors, diagnosis, treatment, outcomes, controversies, and resources for family support.
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Affiliation(s)
- R Srivastava
- Division of Pediatric Neurology, Department of Pediatrics, University of Albertam, AB, Canada
| | - J Mailo
- Division of Pediatric Neurology, Department of Pediatrics, University of Albertam, AB, Canada
| | - M Dunbar
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada.
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9
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Kirton A, Jordan LC, Orbach DB, Fullerton HJ. The case against endovascular thrombectomy in neonates with arterial ischemic stroke. Clin Neuroradiol 2022; 32:581-582. [PMID: 35648152 DOI: 10.1007/s00062-022-01153-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Adam Kirton
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lori C Jordan
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Darren B Orbach
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
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10
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Gonzalez F, Ferriero DM. Stem cells for perinatal stroke. Lancet Neurol 2022; 21:497-499. [DOI: 10.1016/s1474-4422(22)00142-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
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11
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Sporns PB, Fullerton HJ, Lee S, Kim H, Lo WD, Mackay MT, Wildgruber M. Childhood stroke. Nat Rev Dis Primers 2022; 8:12. [PMID: 35210461 DOI: 10.1038/s41572-022-00337-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 01/09/2023]
Abstract
Stroke is an important cause of neurological morbidity in children; most survivors have permanent neurological deficits that affect the remainder of their life. Stroke in childhood, the focus of this Primer, is distinguished from perinatal stroke, defined as stroke before 29 days of age, because of its unique pathogenesis reflecting the maternal-fetal unit. Although approximately 15% of strokes in adults are haemorrhagic, half of incident strokes in children are haemorrhagic and half are ischaemic. The causes of childhood stroke are distinct from those in adults. Urgent brain imaging is essential to confirm the stroke diagnosis and guide decisions about hyperacute therapies. Secondary stroke prevention strongly depends on the underlying aetiology. While the past decade has seen substantial advances in paediatric stroke research, the quality of evidence for interventions, such as the rapid reperfusion therapies that have revolutionized arterial ischaemic stroke care in adults, remains low. Substantial time delays in diagnosis and treatment continue to challenge best possible care. Effective primary stroke prevention strategies in children with sickle cell disease represent a major success, yet barriers to implementation persist. The multidisciplinary members of the International Pediatric Stroke Organization are coordinating global efforts to tackle these challenges and improve the outcomes in children with cerebrovascular disease.
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Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, Benioff Children's Hospital, University of California at San Francisco, San Francisco, CA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Helen Kim
- Departments of Anesthesia and Perioperative Care, and Epidemiology and Biostatistics, Center for Cerebrovascular Research, University of California at San Francisco, San Francisco, CA, USA
| | - Warren D Lo
- Departments of Pediatrics and Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Mark T Mackay
- Department of Neurology, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Moritz Wildgruber
- Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany.
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