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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] [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]
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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Neukomm A, Claessens NHP, Bonthrone AF, Stegeman R, Feldmann M, Nijman M, Jansen NJG, Nijman J, Groenendaal F, de Vries LS, Benders MJNL, Breur JMPJ, Haas F, Bekker MN, Logeswaran T, Reich B, Kottke R, Dave H, Simpson J, Pushparajah K, Kelly CJ, Arulkumaran S, Rutherford MA, Counsell SJ, Chew A, Knirsch W, Sprong MCA, van Schooneveld MM, Hagmann C, Latal B. Perioperative Brain Injury in Relation to Early Neurodevelopment Among Children with Severe Congenital Heart Disease: Results from a European Collaboration. J Pediatr 2024; 266:113838. [PMID: 37995930 DOI: 10.1016/j.jpeds.2023.113838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/23/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To examine the relationship between perioperative brain injury and neurodevelopment during early childhood in patients with severe congenital heart disease (CHD). STUDY DESIGN One hundred and seventy children with CHD and born at term who required cardiopulmonary bypass surgery in the first 6 weeks after birth were recruited from 3 European centers and underwent preoperative and postoperative brain MRIs. Uniform description of imaging findings was performed and an overall brain injury score was created, based on the sum of the worst preoperative or postoperative brain injury subscores. Motor and cognitive outcomes were assessed with the Bayley Scales of Infant and Toddler Development Third Edition at 12 to 30 months of age. The relationship between brain injury score and clinical outcome was assessed using multiple linear regression analysis, adjusting for CHD severity, length of hospital stay (LOS), socioeconomic status (SES), and age at follow-up. RESULTS Neither the overall brain injury score nor any of the brain injury subscores correlated with motor or cognitive outcome. The number of preoperative white matter lesions was significantly associated with gross motor outcome after correction for multiple testing (P = .013, β = -0.50). SES was independently associated with cognitive outcome (P < .001, β = 0.26), and LOS with motor outcome (P < .001, β = -0.35). CONCLUSION Preoperative white matter lesions appear to be the most predictive MRI marker for adverse early childhood gross motor outcome in this large European cohort of infants with severe CHD. LOS as a marker of disease severity, and SES influence outcome and future intervention trials need to address these risk factors.
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Affiliation(s)
- Astrid Neukomm
- Child Development Center, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Congenital Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Raymond Stegeman
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria Feldmann
- Child Development Center, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Maaike Nijman
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Congenital Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas J G Jansen
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Joppe Nijman
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Felix Haas
- Congenital Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thushiha Logeswaran
- Pediatric Heart Center, University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bettina Reich
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Raimund Kottke
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hitendu Dave
- Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - John Simpson
- Pediatric Cardiology Department, Evelina Children's Hospital London, London, United Kingdom
| | - Kuberan Pushparajah
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Pediatric Cardiology Department, Evelina Children's Hospital London, London, United Kingdom
| | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sophie Arulkumaran
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Walter Knirsch
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, Children's Research Center, University Children's Hospital, University of Zurich, Zurich, Switzerland
| | - Maaike C A Sprong
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique M van Schooneveld
- Department of Pediatric Psychology, Neuropsychology Section, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelia Hagmann
- Department of Neonatology and Pediatric Intensive Care, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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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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4
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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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5
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Frazier AP, Mitchell DN, Given KS, Hunn G, Burch AM, Childs CR, Moreno-Garcia M, Corigilano MR, Quillinan N, Macklin WB, Herson PS, Dingman AL. Chronic changes in oligodendrocyte sub-populations after middle cerebral artery occlusion in neonatal mice. Glia 2023; 71:1429-1450. [PMID: 36794545 DOI: 10.1002/glia.24349] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/17/2023]
Abstract
Neonatal stroke is common and causes life-long motor and cognitive sequelae. Because neonates with stroke are not diagnosed until days-months after the injury, chronic targets for repair are needed. We evaluated oligodendrocyte maturity and myelination and assessed oligodendrocyte gene expression changes using single cell RNA sequencing (scRNA seq) at chronic timepoints in a mouse model of neonatal arterial ischemic stroke. Mice underwent 60 min of transient right middle cerebral artery occlusion (MCAO) on postnatal day 10 (p10) and received 5-ethynyl-2'-deoxyuridine (EdU) on post-MCAO days 3-7 to label dividing cells. Animals were sacrificed 14 and 28-30 days post-MCAO for immunohistochemistry and electron microscopy. Oligodendrocytes were isolated from striatum 14 days post-MCAO for scRNA seq and differential gene expression analysis. The density of Olig2+ EdU+ cells was significantly increased in ipsilateral striatum 14 days post-MCAO and the majority of oligodendrocytes were immature. Density of Olig2+ EdU+ cells declined significantly between 14 and 28 days post-MCAO without a concurrent increase in mature Olig2+ EdU+ cells. By 28 days post-MCAO there were significantly fewer myelinated axons in ipsilateral striatum. scRNA seq identified a cluster of "disease associated oligodendrocytes (DOLs)" specific to the ischemic striatum, with increased expression of MHC class I genes. Gene ontology analysis suggested decreased enrichment of pathways involved in myelin production in the reactive cluster. Oligodendrocytes proliferate 3-7 days post-MCAO and persist at 14 days, but fail to mature by 28 days. MCAO induces a subset of oligodendrocytes with reactive phenotype, which may be a therapeutic target to promote white matter repair.
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Affiliation(s)
- Alexandra P Frazier
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Danae N Mitchell
- Department of Pediatrics, Division of Child Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Katherine S Given
- Department of Developmental and Cell Biology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Genevieve Hunn
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amelia M Burch
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christine R Childs
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Myriam Moreno-Garcia
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael R Corigilano
- Department of Graduate Medical Education, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nidia Quillinan
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wendy B Macklin
- Department of Developmental and Cell Biology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Paco S Herson
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, USA
| | - Andra L Dingman
- Department of Pediatrics, Division of Child Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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6
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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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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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8
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Yin H, Wang X, Yang H, Zhu X, Wang J, Li Z. A pilot study of the General Movement Optimality Score detects early signs of motor disorder in neonates with arterial ischemic stroke. Early Hum Dev 2021; 163:105484. [PMID: 34655917 DOI: 10.1016/j.earlhumdev.2021.105484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 08/12/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
AIM To explore whether the General Movement Optimality Score (GMOS) could help to identify asymmetric movement in infants with neonatal arterial ischemic stroke (NAIS) in the early stage. METHOD Twenty-seven infants with NAIS (16 males, 11 females) were enrolled. The general movement video was recorded approximately one month after birth. The GMOS focused separately on the neck and trunk and the upper and lower extremities. The differences between the ipsilesional and contralesional limbs were analyzed. RESULTS Eight infants who developed cerebral palsy (CP) had middle cerebral artery (MCA) infarction involving the main branch. By GMOS evaluation, the scores of the contralesional upper and/or lower limbs were lower than those of the ipsilesional side (p < 0.05). In the contralesional limbs, the CP group had a lower GMOS than the non-CP group. Distal rotatory components of the contralesional upper limbs and tremulous movement of the lower limbs showed significant differences. INTERPRETATION The GMOS could help to quantitatively find and assess the asymmetric movement of global and contralesional limbs. Distal rotatory movement of the upper limbs could be an early sign of abnormal motor function in infants with NAIS.
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Affiliation(s)
- Huanhuan Yin
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Xinrui Wang
- Department of Neonatology, Children's Hospital of Fudan University, Key Laboratory of Neonatal Disease, National Health Commission, Shanghai 201102, China
| | - Hong Yang
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Xiaoyun Zhu
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Jun Wang
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China.
| | - Zhihua Li
- Department of Neonatology, Children's Hospital of Fudan University, Key Laboratory of Neonatal Disease, National Health Commission, Shanghai 201102, China.
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9
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Aprasidze T, Tatishvili N, Shatirishvili T, Lomidze G. Predictors of Neurological Outcome of Arterial Ischemic Stroke in Children. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0040-1701204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AbstractStroke is an important cause of mortality and morbidity in children. The aim of the study was to evaluate long-term neurological outcome in children with arterial ischemic stroke (AIS) and explore predictive factors that affect poor outcome. Fifty-six patients aged between 1 month and 17 years who were treated at M. Iashvili Children's Central Hospital, Tbilisi, Georgia, with an onset of stroke from 2007 to 2017 were included. To explore predictive factors of outcome, the following data were collected: demographic characteristics, risk factors, he presenting signs, radiological features, and presence of stroke recurrence. Neurological status at discharge and long-term neurological outcome at least 1 year after stroke was evaluated according to Pediatric Stroke Outcome Measure subscale. The reported outcome after childhood stroke was variable with long-term neurological deficits in one-third of patients (30.4%). The neurological outcome was worse in males, in patients with multiple stroke episodes, and in those with infarctions involving a combination of cortical and subcortical areas. Pediatric AIS carries the risk of long-term morbidity, and neuroimaging has a predictive influence on outcome.
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Affiliation(s)
- Tatia Aprasidze
- Department of Medicine, David Tvildiani Medical University, Tbilisi, Georgia
- Department of Neuroscience, M. Iashvili Children's Central Hospital, Tbilisi, Georgia
| | - Nana Tatishvili
- Department of Medicine, David Tvildiani Medical University, Tbilisi, Georgia
- Department of Neuroscience, M. Iashvili Children's Central Hospital, Tbilisi, Georgia
| | - Teona Shatirishvili
- Department of Medicine, David Tvildiani Medical University, Tbilisi, Georgia
- Department of Neuroscience, M. Iashvili Children's Central Hospital, Tbilisi, Georgia
| | - Giorgi Lomidze
- Department of Epilepsy, Institute of Neurology and Neuropsychology, Tbilisi, Georgia
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10
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Motor outcome after perinatal stroke and early prediction of unilateral spastic cerebral palsy. Eur J Paediatr Neurol 2020; 29:54-61. [PMID: 32988734 DOI: 10.1016/j.ejpn.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/11/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Unilateral spastic cerebral palsy (USCP) occurs in 30%-68% of infants with perinatal stroke. Early detection of USCP is essential for referring infants to early intervention. The aims of this study were to report motor outcomes after perinatal stroke, and to determine the predictive value of the General Movements Assessment (GMA) and Hand Assessment for Infants (HAI) for detection of USCP. MATERIALS AND METHODS This was a prospective observational study involving infants with perinatal stroke. GMA was conducted between 10 and 15 weeks post term-age (PTA). The HAI was performed between 3 and 5 months PTA. Motor outcome was collected between 12 and 36 months PTA. RESULTS The sample consisted of 46 infants. Fifteen children (32.6%) were diagnosed with CP, two children with bilateral CP and 13 with USCP. Abnormal GMA had a sensitivity of 85% (95% confidence interval [CI] 55-98%) and a specificity of 52% (95% CI 33-71%) to predict USCP. When asymmetrically presented FMs were also considered as abnormal, sensitivity increased to 100%, hence the specificity declined to 43%. A HAI asymmetry index cut-off of 23, had both a sensitivity and a specificity of 100% to detect USCP. CONCLUSION Using GMA and HAI can enable prediction of USCP before the age of 5 months in infants with perinatal stroke. Nevertheless, GMA must be interpreted with caution in this particular population. The HAI was found to be a very accurate screening tool for early detection of asymmetry and prediction of USCP.
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11
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Imaging Developmental and Interventional Plasticity Following Perinatal Stroke. Can J Neurol Sci 2020; 48:157-171. [DOI: 10.1017/cjn.2020.166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT:Perinatal stroke occurs around the time of birth and leads to lifelong neurological disabilities including hemiparetic cerebral palsy. Magnetic resonance imaging (MRI) has revolutionized our understanding of developmental neuroplasticity following early injury, quantifying volumetric, structural, functional, and metabolic compensatory changes after perinatal stroke. Such techniques can also be used to investigate how the brain responds to treatment (interventional neuroplasticity). Here, we review the current state of knowledge of how established and emerging neuroimaging modalities are informing neuroplasticity models in children with perinatal stroke. Specifically, we review structural imaging characterizing lesion characteristics and volumetrics, diffusion tensor imaging investigating white matter tracts and networks, task-based functional MRI for localizing function, resting state functional imaging for characterizing functional connectomes, and spectroscopy examining neurometabolic changes. Key challenges and exciting avenues for future investigations are also considered.
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12
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Wagenaar N, Verhage CH, de Vries LS, van Gasselt BPL, Koopman C, Leemans A, Groenendaal F, Benders MJNL, van der Aa NE. Early prediction of unilateral cerebral palsy in infants at risk: MRI versus the hand assessment for infants. Pediatr Res 2020; 87:932-939. [PMID: 31722367 DOI: 10.1038/s41390-019-0664-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/16/2019] [Accepted: 10/01/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neonates with unilateral perinatal brain injury (UPBI) are at risk for developing unilateral spastic cerebral palsy (USCP). This study compares several predictors for USCP later in life. METHODS Twenty-one preterm and 24 term born infants with UPBI were included, with an MRI scan including diffusion tensor imaging (DTI) performed at term equivalent age or around 3 months after birth, respectively. T2-weighted images and DTI-based tractography were used to measure the surface area, diameter, and fractional anisotropy (FA) of both corticospinal tracts (CSTs). The hand assessment for infants (HAI) was performed before 5, between 5 and 8 and between 8 and 12 months of (corrected) age. Asymmetry indices were derived from all techniques and related to USCP at ≥2 years of age. RESULTS MRI measures and HAI scores were significantly lower for the affected compared to the unaffected side. Before 5 months of age, FA asymmetry on DTI yielded the highest area under the curve compared to conventional MRI and HAI. CONCLUSIONS Prediction of USCP after UPBI is reliable using asymmetry of the CST on MRI, as well as clinical hand assessment. Before 5 months of age, DTI tractography provides strongest predictive information, while HAI specifically aids to prognosis of USCP at later age points.
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Affiliation(s)
- Nienke Wagenaar
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelia H Verhage
- Child Development and Exercise Centre, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bram P L van Gasselt
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Corine Koopman
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Niek E van der Aa
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. .,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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13
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Mackay MT, Slavova N, Pastore-Wapp M, Grunt S, Stojanovski B, Donath S, Steinlin M. Pediatric ASPECTS predicts outcomes following acute symptomatic neonatal arterial stroke. Neurology 2020; 94:e1259-e1270. [DOI: 10.1212/wnl.0000000000009136] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/05/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo test the hypothesis that the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is useful in determining outcomes after neonatal arterial ischemic stroke (NAIS), we assessed accuracy of the modified pediatric ASPECTS (pedASPECTS) to predict cerebral palsy (CP), neurologic impairment, and epilepsy.MethodsCross-sectional study included newborns with acute NAIS whose outcomes were assessed at ≥18 months after stroke. PedASPECTS accuracy to predict outcomes was determined by sensitivity, specificity, and receiver operator characteristic (ROC) curves, and correlation between pedASPECTS and infarct volume was determined by the Spearman correlation coefficient.ResultsNinety-six children met the inclusion criteria. Median percentage infarct to supratentorial brain volume was 6.8% (interquartile range [IQR] 3.0%–14.3%). Median pedASPECTS was 7 (IQR 4–10). At a median age of 2.1 years, 35% developed CP, 43% had neurologic impairment, and 7% had epilepsy. Median pedASPECTS predicted outcomes of interest: CP (10, IQR 8–12) vs no CP (5, IQR 4–8) (p < 0.0001), poor (9, IQR 7–12) vs good (6, IQR 4–8) neurologic outcomes (p < 0.0001), and epilepsy (10, IQR 8–12) vs no epilepsy (7, IQR 4–10) (p = 0.033). PedASPECTS accuracy was good for CP (ROC 0.811) and fair for neurologic impairment (ROC 0.760) and epilepsy (ROC 0.761). A pedASPECTS ≥8 had ≥69% sensitivity and ≥54% specificity for clinical outcomes. PedASPECTS correlated with infarct volume (Spearman rank 0.701, p < 0.0001).ConclusionsThis study provides Class II evidence that pedASPECTS has fair to good accuracy for predicting CP, neurologic impairment, and epilepsy after NAIS and correlates with infarct volume. PedASPECTS may assist with early identification of babies requiring close developmental surveillance.
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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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15
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Sisa C, Agha-Shah Q, Sanghera B, Carno A, Stover C, Hristova M. Properdin: A Novel Target for Neuroprotection in Neonatal Hypoxic-Ischemic Brain Injury. Front Immunol 2019; 10:2610. [PMID: 31849925 PMCID: PMC6902041 DOI: 10.3389/fimmu.2019.02610] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 10/21/2019] [Indexed: 11/14/2022] Open
Abstract
Background: Hypoxic-ischemic (HI) encephalopathy is a major cause of neonatal mortality and morbidity, with a global incidence of 3 per 1,000 live births. Intrauterine or perinatal complications, including maternal infection, constitute a major risk for the development of neonatal HI brain damage. During HI, inflammatory response and oxidative stress occur, causing subsequent cell death. The presence of an infection sensitizes the neonatal brain, making it more vulnerable to the HI damage. Currently, therapeutic hypothermia is the only clinically approved treatment available for HI encephalopathy, however it is only partially effective in HI alone and its application in infection-sensitized HI is debatable. Therefore, there is an unmet clinical need for the development of novel therapeutic interventions for the treatment of HI. Such an alternative is targeting the complement system. Properdin, which is involved in stabilization of the alternative pathway convertases, is the only known positive regulator of alternative complement activation. Absence of the classical pathway in the neonatal HI brain is neuroprotective. However, there is a paucity of data on the participation of the alternative pathway and in particular the role of properdin in HI brain damage. Objectives: Our study aimed to validate the effect of global properdin deletion in two mouse models: HI alone and LPS-sensitized HI, thus addressing two different clinical scenarios. Results: Our results indicate that global properdin deletion in a Rice-Vannucci model of neonatal HI and LPS-sensitized HI brain damage, in the short term, clearly reduced forebrain cell death and microglial activation, as well as tissue loss. In HI alone, deletion of properdin reduced TUNEL+ cell death and microglial post-HI response at 48 h post insult. Under the conditions of LPS-sensitized HI, properdin deletion diminished TUNEL+ cell death, tissue loss and microglial activation at 48 h post-HI. Conclusion: Overall, our data suggests a critical role for properdin, and possibly also a contribution in neonatal HI alone and in infection-sensitized HI brain damage. Thus, properdin can be considered a novel target for treatment of neonatal HI brain damage.
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Affiliation(s)
- Claudia Sisa
- Perinatal Brain Repair Group, UCL Institute for Women's Health, Maternal & Fetal Medicine, London, United Kingdom
| | - Qudsiyah Agha-Shah
- Perinatal Brain Repair Group, UCL Institute for Women's Health, Maternal & Fetal Medicine, London, United Kingdom
| | - Balpreet Sanghera
- Perinatal Brain Repair Group, UCL Institute for Women's Health, Maternal & Fetal Medicine, London, United Kingdom
| | - Ariela Carno
- Perinatal Brain Repair Group, UCL Institute for Women's Health, Maternal & Fetal Medicine, London, United Kingdom
| | - Cordula Stover
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Mariya Hristova
- Perinatal Brain Repair Group, UCL Institute for Women's Health, Maternal & Fetal Medicine, London, United Kingdom
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Ryll UC, Wagenaar N, Verhage CH, Blennow M, de Vries LS, Eliasson AC. Early prediction of unilateral cerebral palsy in infants with asymmetric perinatal brain injury - Model development and internal validation. Eur J Paediatr Neurol 2019; 23:621-628. [PMID: 31078397 DOI: 10.1016/j.ejpn.2019.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 03/20/2019] [Accepted: 04/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early diagnosis of unilateral cerebral palsy is important after asymmetric perinatal brain injury (APBI). Our objective is to estimate the risk of unilateral cerebral palsy (UCP) in infants with APBI during the first months of life using neuroimaging and clinical assessment. PATIENTS AND METHODS Prognostic multivariable prediction modeling study including 52 infants (27 males), median gestational age 39.3 weeks with APBI from Sweden (n = 33) and the Netherlands (n = 19). INCLUSION CRITERIA (1) neonatal MRI within one month after term equivalent age (TEA), (2) Hand Assessment for Infants (HAI) between 3.5 and 4.5 months of (corrected) age. UCP was diagnosed ≥24 months of age. Firth regression with cross-validation was used to construct and internally validate the model to estimate the risk for UCP based on the predictors corticospinal tract (CST) and basal ganglia/thalamus (BGT) involvement, contralesional HAI Each hand sum score (EaHS), gestational age and sex. RESULTS UCP was diagnosed in 18 infants (35%). Infants who developed UCP more often had involvement of the CST and BGT on neonatal MRI and had lower contralesional HAI EaHS compared to those who did not develop UCP. The final model showed excellent accuracy for UCP prediction between 3.5 and 4.5 months (area under the curve, AUC = 0.980; 95% CI 0.95-1.00). CONCLUSIONS Combining neonatal MRI, the HAI, gestational age and sex accurately identify the prognostic risk of UCP at 3.5-4.5 months in infants with APBI.
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Affiliation(s)
- Ulrike C Ryll
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Nienke Wagenaar
- University Medical Center Utrecht, Department of Neonatology, Utrecht, the Netherlands
| | - Cornelia H Verhage
- University Medical Center Utrecht, Child Development and Exercise Center, Utrecht, the Netherlands
| | - Mats Blennow
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Linda S de Vries
- University Medical Center Utrecht, Department of Neonatology, Utrecht, the Netherlands
| | - Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Sisa C, Kholia S, Naylor J, Herrera Sanchez MB, Bruno S, Deregibus MC, Camussi G, Inal JM, Lange S, Hristova M. Mesenchymal Stromal Cell Derived Extracellular Vesicles Reduce Hypoxia-Ischaemia Induced Perinatal Brain Injury. Front Physiol 2019; 10:282. [PMID: 30941062 PMCID: PMC6433879 DOI: 10.3389/fphys.2019.00282] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/04/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Neonatal hypoxic-ischemic (HI) insult is a leading cause of disability and death in newborns, with therapeutic hypothermia being the only currently available clinical intervention. Thus there is a great need for adjunct and novel treatments for enhanced or alternative post-HI neuroprotection. Extracellular vesicles (EVs) derived from mesenchymal stromal/stem cells (MSCs) have recently been shown to exhibit regenerative effects in various injury models. Here we present findings showing neuroprotective effects of MSC-derived EVs in the Rice-Vannucci model of severe HI-induced neonatal brain insult. METHODS Mesenchymal stromal/stem cell-derived EVs were applied intranasally immediately post HI-insult and behavioral outcomes were observed 48 h following MSC-EV treatment, as assessed by negative geotaxis. Brains were thereafter excised and assessed for changes in glial responses, cell death, and neuronal loss as markers of damage at 48 h post HI-insult. RESULTS Brains of the MSC-EV treated group showed a significant decrease in microglial activation, cell death, and percentage tissue volume loss in multiple brain regions, compared to the control-treated groups. Furthermore, negative geotaxis test showed improved behavioral outcomes at 48 h following MSC-EV treatment. CONCLUSION Our findings highlight the clinical potential of using MSC-derived EVs following neonatal hypoxia-ischaemia.
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Affiliation(s)
- Claudia Sisa
- Perinatal Brain Protection and Repair Group, EGA Institute for Women’s Health, University College London, London, United Kingdom
| | - Sharad Kholia
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jordan Naylor
- Perinatal Brain Protection and Repair Group, EGA Institute for Women’s Health, University College London, London, United Kingdom
| | | | - Stefania Bruno
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria Chiara Deregibus
- 2i3T, Incubator and Technology Transfer, Molecular Biotechnology Center, University of Turin, Turin, Italy
| | - Giovanni Camussi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jameel M. Inal
- Extracellular Vesicle Research Unit and Bioscience Research Group, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Sigrun Lange
- Tissue Architecture and Regeneration Research Group, School of Life Sciences, University of Westminster, London, United Kingdom
| | - Mariya Hristova
- Perinatal Brain Protection and Repair Group, EGA Institute for Women’s Health, University College London, London, United Kingdom
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Cooper AN, Anderson V, Greenham M, Hearps S, Hunt RW, Mackay MT, Ditchfield M, Coleman L, Monagle P, Gordon AL. Motor function daily living skills 5 years after paediatric arterial ischaemic stroke: a prospective longitudinal study. Dev Med Child Neurol 2019; 61:161-167. [PMID: 29845603 DOI: 10.1111/dmcn.13915] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 01/14/2023]
Abstract
AIM To describe 5-year motor and functional outcomes after paediatric arterial ischaemic stroke (AIS) and to explore factors associated with poorer long-term outcome. METHOD Thirty-three children (21 males, 12 females) with AIS were recruited to a single-site, cross-sectional study, from a previously reported prospective longitudinal stroke outcome study. Children were stratified according to age at diagnosis: neonates (≤30d), preschool (>30d-5y), and school age (≥5y). Motor and functional outcomes were measured at 5 years after stroke. Neurological outcomes were evaluated using the Pediatric Stroke Outcome Measure (PSOM) at 1 month and more than 4 years after stroke. RESULTS At 5 years after stroke, motor function, quality of life, fatigue, adaptive behaviour, activities of daily living, and handwriting speed were significantly poorer than age expectations. The preschool group had the highest percentage of fine and gross motor impairment. Poorer fine motor skills were associated with subcortical-only lesions and large lesion size. Poorer gross motor outcomes correlated with preschool age, bilateral lesions, and PSOM impairment at 1 month. INTERPRETATION Children are at elevated risk for motor and functional impairments after AIS, with the preschool age group most vulnerable. Identifying early predictors of poorer outcomes facilitates targeted early intervention and long-term rehabilitation. WHAT THIS PAPER ADDS Following paediatric stroke, children are at elevated risk of motor and functional difficulties. Stroke occurring between 30 days and 5 years of age may result in poorer motor and functional outcomes.
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Affiliation(s)
- Anna N Cooper
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,University of Melbourne, Melbourne, Vic., Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,University of Melbourne, Melbourne, Vic., Australia.,The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Mardee Greenham
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,University of Melbourne, Melbourne, Vic., Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,University of Melbourne, Melbourne, Vic., Australia
| | - Rod W Hunt
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,University of Melbourne, Melbourne, Vic., Australia.,The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Mark T Mackay
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,University of Melbourne, Melbourne, Vic., Australia.,The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Michael Ditchfield
- Monash Medical Centre, Southern Health, Melbourne, Vic., Australia.,Monash University, Melbourne, Vic., Australia
| | - Lee Coleman
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,The Royal Children's Hospital, Melbourne, Vic., Australia.,Monash Medical Centre, Southern Health, Melbourne, Vic., Australia
| | - Paul Monagle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,University of Melbourne, Melbourne, Vic., Australia.,The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Anne L Gordon
- Evelina London Children's Hospital, Guy's and St Thomas', NHS Foundation Trust, London, UK.,Kings College London, London, UK
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19
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Woodward KE, Carlson HL, Kuczynski A, Saunders J, Hodge J, Kirton A. Sensory-motor network functional connectivity in children with unilateral cerebral palsy secondary to perinatal stroke. Neuroimage Clin 2019; 21:101670. [PMID: 30642756 PMCID: PMC6412078 DOI: 10.1016/j.nicl.2019.101670] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/23/2018] [Accepted: 01/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Perinatal stroke is the most common cause of unilateral cerebral palsy. Mechanisms of post-stroke developmental plasticity in children are poorly understood. To better understand the relationship between functional connectivity and disability, we used resting-state fMRI to compare sensorimotor connectivity with clinical dysfunction. METHODS School-aged children with periventricular venous infarction (PVI) and unilateral cerebral palsy were compared to controls. Resting-state BOLD signal was acquired on 3 T MRI and analyzed using CONN in SPM12. Functional connectivity was computed between S1, M1, supplementary motor area (SMA), and thalamus of the left/non-lesioned and right/lesioned hemisphere. Primary outcome was connectivity expressed as a Fisher-transformed correlation coefficient. Motor function was measured using the Assisting Hand Assessment (AHA), and Melbourne Assessment (MA). Proprioceptive function was measured using a robotic position matching task (VarXY). RESULTS Participants included 15 PVI and 21 controls. AHA and MA in stroke patients were negatively correlated with connectivity (increased connectivity = poorer performance). Position sense was inversely correlated with connectivity (increased connectivity = improved performance) between the non-lesioned S1 and thalamus/SMA. In controls, VarXY was positively correlated with connectivity between the thalamus and bilateral sensorimotor regions. CONCLUSIONS Resting state fMRI measures of sensorimotor connectivity are associated with clinical sensorimotor function in children with unilateral cerebral palsy secondary to PVI. Greater insight into understanding reorganization of brain networks following perinatal stroke may facilitate personalized rehabilitation.
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Affiliation(s)
- K E Woodward
- Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada.
| | - H L Carlson
- Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada.
| | - A Kuczynski
- Department of Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N4N1, Canada.
| | - J Saunders
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada.
| | - J Hodge
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada.
| | - A Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, 2888 Shaganappi Trial NW, Calgary, AB T3B6A8, Canada; Department of Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N4N1, Canada.
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20
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Abstract
Perinatal arterial ischemic stroke is a relatively common and serious neurologic disorder that can affect the fetus, the preterm, and the term-born infant. It carries significant long-term disabilities. Herein we describe the current understanding of its etiology, pathophysiology and classification, different presentations, and optimal early management. We discuss the role of different brain imaging modalities in defining the extent of lesions and the impact this has on the prediction of outcomes. In recent years there has been progress in treatments, making early diagnosis and the understanding of likely morbidities imperative. An overview is given of the range of possible outcomes and optimal approaches to follow-up and support for the child and their family in the light of present knowledge.
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21
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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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22
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Counsell SJ, Arichi T, Arulkumaran S, Rutherford MA. Fetal and neonatal neuroimaging. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:67-103. [PMID: 31324329 DOI: 10.1016/b978-0-444-64029-1.00004-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Magnetic resonance imaging (MRI) can provide detail of the soft tissues of the fetal and neonatal brain that cannot be obtained by any other imaging modality. Conventional T1 and T2 weighted sequences provide anatomic detail of the normally developing brain and can demonstrate lesions, including those associated with preterm birth, hypoxic ischemic encephalopathy, perinatal arterial stroke, infections, and congenital malformations. Specialized imaging techniques can be used to assess cerebral vasculature (magnetic resonance angiography and venography), cerebral metabolism (magnetic resonance spectroscopy), cerebral perfusion (arterial spin labeling), and function (functional MRI). A wealth of quantitative tools, most of which were originally developed for the adult brain, can be applied to study the developing brain in utero and postnatally including measures of tissue microstructure obtained from diffusion MRI, morphometric studies to measure whole brain and regional tissue volumes, and automated approaches to study cortical folding. In this chapter, we aim to describe different imaging approaches for the fetal and neonatal brain, and to discuss their use in a range of clinical applications.
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Affiliation(s)
- Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sophie Arulkumaran
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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23
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Abstract
Neonatal Arterial Ischemic Stroke (NAIS) affects 6-17 newborns on 100 000-birth term neonates, most of these children keeping long-term motor and cognitive impairments. Based on a literature review, the objectives of this paper are to describe motor and cognitive outcomes after a NAIS and to propose a consensual monitoring of these children to improve their management. About 30 % of children after a NAIS will develop a unilateral cerebral palsy requiring a management by a team with expertise in physical medicine and rehabilitation. Unlike adults, especially after a left NAIS, children will not present aphasia but between 50 and 90 % will present disorders of speech and language in expression and/or reception. After NAIS, the global intellectual efficiency is usually preserved except when the size of the lesion is very important or when severe epilepsy occurs. Several studies are also in favor of vulnerability in visuospatial functions. To quantify impairments, activity limitations and participation restrictions resulting from this NAIS, early and at least yearly evaluations with reliable tools must be carried out systematically until puberty. A multidisciplinary team with a longitudinal follow-up, in all the different developmental dimensions, must conduct these evaluations in term of motor skills, cognitive impairment, behavior, autonomy, quality of life, and participation. Consequences on family functioning need to be evaluate in order to help children and family coping with this event.
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24
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Saunders J, Carlson HL, Cortese F, Goodyear BG, Kirton A. Imaging functional motor connectivity in hemiparetic children with perinatal stroke. Hum Brain Mapp 2018; 40:1632-1642. [PMID: 30447082 DOI: 10.1002/hbm.24474] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 01/18/2023] Open
Abstract
Perinatal stroke causes lifelong disability, particularly hemiparetic cerebral palsy. Arterial ischemic strokes (AIS) are large, cortical, and subcortical injuries acquired near birth due to acute occlusion of the middle cerebral artery. Periventricular venous infarctions (PVI) are smaller, subcortical strokes acquired prior to 34 weeks gestation involving injury to the periventricular white matter. Both stroke types can damage motor pathways, thus, we investigated resulting alterations in functional motor networks and probed function. We measured blood oxygen level dependent (BOLD) fluctuations at rest in 38 participants [10 arterial patients (age = 14.7 ± 4.1 years), 10 venous patients (age = 13.5 ± 3.7 years), and 18 typically developing controls (TDCs) (age = 15.3 ± 5.1 years)] and explored strength and laterality of functional connectivity in the motor network. Inclusion criteria included MRI-confirmed, unilateral perinatal stroke, symptomatic hemiparetic cerebral palsy, and 6-19 years old at time of imaging. Seed-based functional connectivity analyses measured temporal correlations in BOLD response over the whole brain using primary motor cortices as seeds. Laterality indices based on mean z-scores in lesioned and nonlesioned hemispheres explored laterality. In AIS patients, significant differences in both strength and laterality of motor network connections were observed compared with TDCs. In PVI patients, motor networks largely resembled those of healthy controls, albeit slightly weaker and asymmetric, despite subcortical damage and hemiparesis. Functional connectivity strengths were not related to motor outcome scores for either stroke group. This study serves as a foundation to better understand how resting-state fMRI can assess motor functional connectivity and potentially be applied to explore mechanisms of interventional therapies after perinatal stroke.
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Affiliation(s)
- Jennifer Saunders
- Neuroscience Graduate Program, University of Calgary, Calgary, Alberta, Canada.,Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Filomeno Cortese
- Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Departments of Radiology and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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25
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Lõo S, Ilves P, Männamaa M, Laugesaar R, Loorits D, Tomberg T, Kolk A, Talvik I, Talvik T, Haataja L. Long-term neurodevelopmental outcome after perinatal arterial ischemic stroke and periventricular venous infarction. Eur J Paediatr Neurol 2018; 22:1006-1015. [PMID: 30249407 DOI: 10.1016/j.ejpn.2018.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/04/2018] [Accepted: 07/16/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-term follow-up data after different vascular types of ischemic perinatal stroke is sparse. Our aim was to study neurodevelopmental outcomes following neonatal and presumed perinatal ischemic middle cerebral artery territory stroke (arterial ischemic stroke, AIS) and periventricular venous infarction (PVI). METHODS A prospective consecutive cohort of 40 term-born children with perinatal stroke (21 AIS, 19 PVI) was identified through the Estonian Paediatric Stroke Database. While 48% of the children with AIS were diagnosed during the neonatal period, all the children with PVI had presumed perinatal stroke. Outcomes based on the Paediatric Stroke Outcome Measure (PSOM) and Kaufman Assessment Battery for Children - Second Edition (K-ABC-II), in relation to extent and laterality of stroke, were defined. RESULTS At a median age of 7 years 6 months (range 3.6-13y), there was a trend towards worse neurodevelopmental outcome in participants with AIS when compared to PVI (mean total PSOM scores 3.1 and 2.2, respectively; p = 0.06). Combined deficits of motor, language and cognitive/behavioural functions were significantly more common among children with AIS (90%) when compared to children with PVI (53%, p = 0.007). General cognitive ability (by K-ABC-II) was significantly lower in the AIS subgroup (mean 79.6; 95% CI 72.3-87.0), but children with PVI (91.6; 95% CI 85.5-97.8) also had poorer performance than the age-equivalent normative mean. Large extent of stroke was associated with poorer neurodevelopmental outcome and lower cognitive performance in children following AIS but not in PVI. CONCLUSION In this national cohort, poor long-term neurodevelopmental outcome after perinatal ischemic stroke was seen irrespective of the vascular type or time of diagnosis of stroke. However, the spectrum of neurological deficits is different after perinatal AIS and PVI, with combined deficits more common among children following AIS.
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Affiliation(s)
- Silva Lõo
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Pediatrics, University of Tartu, Tartu, Estonia.
| | - Pilvi Ilves
- Department of Radiology, University of Tartu, Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Mairi Männamaa
- Department of Pediatrics, University of Tartu, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Rael Laugesaar
- Department of Pediatrics, University of Tartu, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Dagmar Loorits
- Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Tiiu Tomberg
- Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Anneli Kolk
- Department of Pediatrics, University of Tartu, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Inga Talvik
- Department of Neurology and Rehabilitation, Tallinn Children's Hospital, Tallinn, Estonia
| | - Tiina Talvik
- Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Leena Haataja
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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26
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Wagenaar N, Martinez-Biarge M, van der Aa NE, van Haastert IC, Groenendaal F, Benders MJNL, Cowan FM, de Vries LS. Neurodevelopment After Perinatal Arterial Ischemic Stroke. Pediatrics 2018; 142:peds.2017-4164. [PMID: 30072575 DOI: 10.1542/peds.2017-4164] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Perinatal arterial ischemic stroke (PAIS) leads to cerebral palsy in ∼30% of affected children and has other neurologic sequelae. Authors of most outcome studies focus on middle cerebral artery (MCA) stroke without differentiating between site and extent of affected tissue. Our aim with this study was to report outcomes after different PAIS subtypes. METHODS Between 1990 and 2015, 188 term infants from 2 centers (London [n = 79] and Utrecht [n = 109]) had PAIS on their neonatal MRI. Scans were reevaluated to classify stroke territory and determine specific tissue involvement. At 18 to 93 (median 41.7) months, adverse neurodevelopmental outcomes were recorded as 1 or more of cerebral palsy, cognitive deficit, language delay, epilepsy, behavioral problems, or visual field defect. RESULTS The MCA territory was most often involved (90%), with posterior or anterior cerebral artery territory strokes occurring in 9% and 1%, respectively. Three infants died, and 24 had scans unavailable for reevaluation or were lost to follow-up. Of 161 infants seen, 54% had an adverse outcome. Outcomes were the same between centers. Main branch MCA stroke resulted in 100% adverse outcome, whereas other stroke subtypes had adverse outcomes in only 29% to 57%. The most important outcome predictors were involvement of the corticospinal tracts and basal ganglia. CONCLUSIONS Although neurodevelopmental outcome was adverse in at least 1 domain with main branch MCA stroke, in other PAIS subtypes outcome was favorable in 43% to 71% of children. Site and tissue involvement is most important in determining the outcome in PAIS.
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Affiliation(s)
- Nienke Wagenaar
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and
| | | | - Niek E van der Aa
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and
| | - Ingrid C van Haastert
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and
| | - Floris Groenendaal
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and
| | - Frances M Cowan
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and
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27
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Abstract
Predicting neurodevelopmental outcomes in high-risk neonates remains challenging despite advances in neonatal care. Early and accurate characterization of infants at risk for neurodevelopmental delays is necessary to best identify those who may benefit from existing early interventions and novel therapies that become available. Although neuroimaging is a promising biomarker in the prediction of neurodevelopmental outcomes in high-risk infants, it requires additional resources and expertise. Despite many advances in neonatal neuroimaging, there remain limitations in relating early neuroimaging findings with long-term outcomes; further studies are necessary to determine the optimal protocols to best identify high-risk patients and improve neurodevelopmental outcome prediction.
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28
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Amlie-Lefond C. Evaluation and Acute Management of Ischemic Stroke in Infants and Children. Continuum (Minneap Minn) 2018; 24:150-170. [PMID: 29432241 DOI: 10.1212/con.0000000000000559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article provides an overview of stroke in neonates, infants, and children. RECENT FINDINGS Arterial ischemic stroke and cerebral venous sinus thrombosis are increasingly recognized in childhood as important causes of lifelong morbidity and mortality. Diagnosis of arterial ischemic stroke is frequently delayed, as acute neurologic deficits can be challenging to detect in the young child, and stroke is often not considered in the differential diagnosis. Neurologic sequelae following stroke are common, and strategies to minimize stroke size and optimize recovery are being developed. Recurrent arterial ischemic stroke is not uncommon, particularly in children with cerebral arteriopathy. Cerebral venous sinus thrombosis causes obstruction of venous outflow leading to venous infarcts. Complications include hemorrhagic conversion of infarcts and increased intracranial pressure. Without treatment, thrombus extension with increased symptoms is common. Robust guidelines of care that exist for adults do not exist for children, particularly for children with arterial ischemic stroke. SUMMARY The approach to stroke in infants and children can be informed by clinical experience in pediatric stroke and cerebral venous sinus thrombosis, the extensive literature on pediatric thrombosis, and extrapolation from data from adult patients.
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Castro Conde JR, Fuentes IQ, Campo CG, Sosa AJ, Millán BR, Expósito SH. EEG findings and outcomes of continuous video-EEG monitoring started prior to initiation of seizure treatment in the perinatal stroke. Early Hum Dev 2018; 120:1-9. [PMID: 29602053 DOI: 10.1016/j.earlhumdev.2018.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/17/2018] [Accepted: 03/22/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND To analyze the findings in the background EEG activity of infants who suffered perinatal stroke. METHODS Eleven neonates born 2009-2014 diagnosed of ischemic stroke by MRI (three of them with multistroke) underwent continuous video-EEG monitoring. Visual and spectral (power spectrum and coherence) analyses of the background EEG was performed in three moments: 1) Onset of EEG recording (prior to initiate seizure treatment), 2) Post-ictal epoch (1-2 h after the last seizure), and 3) one-two days after seizure control. All children aged 2-6 years underwent neurodevelopmental assessment. RESULTS Discontinuity, asymmetry, asynchrony, transients, and relative power spectrum in δ and θ frequency bands increased significantly (p < 0.05) in the post-ictal epoch with respect to onset of EEG recording. After seizure control, discontinuity, asynchrony, and θ power spectrum no longer had significant differences with those found at onset of EEG recording. Significant differences between the ischemic and unaffected hemispheres were found in transients and in β coherence (p = 0.002; p = 0.001, respectively) exclusively in the post-ictal epoch. Seizure burden and time-to-control ranged 5-38 min and 0.5-40 h respectively. Currently, only one child is affected by spastic monoparesis. The intelligence quotients ranged 96-123. CONCLUSIONS The background EEG can undergo significant changes in the post-ictal epoch due to the seizure activity triggered by the perinatal stroke. Most of these EEG changes involve all brain activity and not exclusively the ischemic hemisphere. Many of these modifications in the EEG background reverse following the seizure control. Video-EEG monitoring allows accurate/immediate diagnosis and rapid/intensive treatment of the stroke-associated seizures.
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Affiliation(s)
- José R Castro Conde
- Department of Neonatology, Hospital Universitario de Canarias, Ofra s/n, 38320 La Laguna, Spain; Research Group on Nutrition, Growth, and Child Development, Spain(1).
| | - Itziar Quintero Fuentes
- Department of Clinical Psychology, Psychobiology and Methodology, Faculty of Psychology, Campus de Guajara s/n, 38071 La Laguna, Universidad de La Laguna, Spain; Research Group on Developmental Neuropsychology, Spain(2).
| | | | | | - Beatriz Reyes Millán
- Department of Neonatology, Hospital Universitario Nuestra Señora de La Candelaria, Carretera del Rosario 145, 38010 S/C Tenerife, Spain.
| | - Sergio Hernández Expósito
- Department of Clinical Psychology, Psychobiology and Methodology, Faculty of Psychology, Campus de Guajara s/n, 38071 La Laguna, Universidad de La Laguna, Spain; Research Group on Developmental Neuropsychology, Spain(2).
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30
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Cooper AN, Anderson V, Hearps S, Greenham M, Ditchfield M, Coleman L, Hunt RW, Mackay MT, Monagle P, Gordon AL. Trajectories of Motor Recovery in the First Year After Pediatric Arterial Ischemic Stroke. Pediatrics 2017; 140:peds.2016-3870. [PMID: 28710246 DOI: 10.1542/peds.2016-3870] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Neuromotor impairments are common after pediatric stroke, but little is known about functional motor outcomes. We evaluated motor function and how it changed over the first 12 months after diagnosis. We also examined differences in outcome according to age at diagnosis and whether fine motor (FM) or gross motor (GM) function at 12 months was associated with adaptive behavior. METHODS This prospective, longitudinal study recruited children (N = 64) from The Royal Children's Hospital, Melbourne who were diagnosed with acute arterial ischemic stroke (AIS) between December 2007 and November 2013. Motor assessments were completed at 3 time points after the diagnosis of AIS (1, 6, and 12 months). Children were grouped as follows: neonates (n = 27), preschool-aged (n = 19), and school-aged (n = 18). RESULTS A larger lesion size was associated with poorer GM outcomes at 12 months (P = .016). Neonatal AIS was associated with better FM and GM function initially but with a reduction in z scores over time. For the preschool- and school-aged groups, FM remained relatively stable over time. For GM outcomes, the preschool- and the school-aged age groups displayed similar profiles, with gradual recovery over time. Overall, poor FM and GM outcomes at 12 months were associated with poorer adaptive behavior scores. CONCLUSIONS Motor outcomes and the trajectory of recovery post-AIS differed according to a child's age at stroke onset. These findings indicate that an individualized approach to surveillance and intervention may be needed that is informed in part by age at diagnosis.
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Affiliation(s)
- Anna N Cooper
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Mardee Greenham
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Ditchfield
- Monash Medical Centre, Southern Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Lee Coleman
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rod W Hunt
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mark T Mackay
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Paul Monagle
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anne L Gordon
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; and .,Kings College London, London, United Kingdom
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31
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MR imaging for accurate prediction of outcome after perinatal arterial ischemic stroke: Sooner not necessarily better. Eur J Paediatr Neurol 2017; 21:666-670. [PMID: 28499876 DOI: 10.1016/j.ejpn.2017.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/16/2017] [Accepted: 04/04/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Involvement of the corticospinal tracts after perinatal arterial ischemic stroke (PAIS) is strongly correlated with adverse motor outcome. METHODS Two full-term infants with PAIS, with two early MRI scans available, are reported. RESULTS Diffusion weighted imaging (DWI)-MRI, performed within 24 h following onset of seizures and repeated 48 h later, clearly showed restricted diffusion within the middle cerebral artery territory on both MRIs, but clear patterns of signal intensity changes in the descending corticospinal tracts on the second MRI only. CONCLUSION Since involvement of the corticospinal tracts is essential for prediction of motor outcome, we may need to reconsider optimal timing of MR imaging for prediction of neurodevelopmental outcome after PAIS.
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Perinataler Schlaganfall und Sinusvenenthrombose: Klinik, Diagnostik und therapeutische Ansätze. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-016-0132-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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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Jin JH, Shin JE, Lee SM, Eun HS, Park MS, Park KI, Namgung R. Abnormal neurodevelopmental outcomes are very likely in cases of bilateral neonatal arterial ischaemic stroke. Acta Paediatr 2017; 106:229-235. [PMID: 27809371 DOI: 10.1111/apa.13655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 10/16/2016] [Accepted: 10/31/2016] [Indexed: 01/25/2023]
Abstract
AIM Neonatal arterial ischaemic stroke (AIS) is an important cause of severe neurological disability. This study aimed to analyse the clinical manifestations and outcomes of AIS patients. METHODS We enrolled neonates with AIS admitted to Severance Children's Hospital and Gangnam Severance Hospital between 2008 and 2015. AIS was confirmed using magnetic resonance imaging (MRI). We retrospectively reviewed the clinical manifestations, MRI findings, electroencephalography (EEG) findings and neurodevelopmental outcomes. RESULTS The study comprised 29 neonates (18 boys). The mean follow-up period was 15.4 months (range 6-44 months), and the mean age at diagnosis was 8.1 days. Seizure was the most common symptom (66%). Bilateral involvement was more common than unilateral involvement (52%). The middle cerebral artery was the most commonly identified territory (79%). Abnormal EEG findings were noted in 93% of the cases. Neurodevelopment was normal in 11 (38%) patients, while cerebral palsy and delayed development were noted in eight (28%) and six (21%) patients, respectively. Patients with bilateral involvement were very likely to have abnormal neurodevelopmental outcomes. CONCLUSION Our study showed that abnormal neurodevelopmental outcomes were very likely after cases of neonatal AIS with bilateral involvement, and clinicians should consider early and more effective interventions in such cases.
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Affiliation(s)
- Ju Hyun Jin
- Department of Pediatrics Yonsei University College of Medicine Seoul Korea
| | - Jeong Eun Shin
- Department of Pediatrics Yonsei University College of Medicine Seoul Korea
| | - Soon Min Lee
- Department of Pediatrics Yonsei University College of Medicine Seoul Korea
| | - Ho Seon Eun
- Department of Pediatrics Yonsei University College of Medicine Seoul Korea
| | - Min Soo Park
- Department of Pediatrics Yonsei University College of Medicine Seoul Korea
| | - Kook In Park
- Department of Pediatrics Yonsei University College of Medicine Seoul Korea
| | - Ran Namgung
- Department of Pediatrics Yonsei University College of Medicine Seoul Korea
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Basu AP, Pearse JE, Baggaley J, Watson RM, Rapley T. Participatory design in the development of an early therapy intervention for perinatal stroke. BMC Pediatr 2017; 17:33. [PMID: 28114899 PMCID: PMC5259952 DOI: 10.1186/s12887-017-0797-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perinatal stroke is the leading cause of unilateral (hemiparetic) cerebral palsy, with life-long personal, social and financial consequences. Translational research findings indicate that early therapy intervention has the potential for significant improvements in long-term outcome in terms of motor function. By involving families and health professionals in the development and design stage, we aimed to produce a therapy intervention which they would engage with. METHODS Nine parents of children with hemiparesis and fourteen health professionals involved in the care of infants with perinatal stroke took part in peer review and focus groups to discuss evolving therapy materials, with revisions made iteratively. The materials and approach were also discussed at a meeting of the London Child Stroke Research Reference Group. Focus group data were coded using Normalisation Process Theory constructs to explore potential barriers and facilitators to routine uptake of the intervention. RESULTS We developed the Early Therapy in Perinatal Stroke (eTIPS) program - a parent-delivered, home-based complex intervention addressing a current gap in practice for infants in the first 6 months of life after unilateral perinatal stroke and with the aim of improving motor outcome. Parents and health professionals saw the intervention as different from usual practice, and valuable (high coherence). They were keen to engage (high cognitive participation). They considered the tasks for parents to be achievable (high collective action). They demonstrated trust in the approach and felt that parents would undertake the recommended activities (high collective action). They saw the approach as flexible and adaptable (high reflexive monitoring). Following suggestions made, we added a section on involving the extended family, and obtained funding for a website and videos to supplement written materials. CONCLUSIONS Focus groups with parents and health professionals provided meaningful feedback to iteratively improve the intervention materials prior to embarking on a pilot study. The intervention has a high potential to normalize and become a routine part of parents' interactions with their child following unilateral perinatal stroke.
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Affiliation(s)
- Anna Purna Basu
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU UK
- Department of Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN UK
| | - Janice Elizabeth Pearse
- Therapy Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN UK
| | - Jessica Baggaley
- Medical Sciences Graduate School, Newcastle University, Newcastle upon Tyne, NE1 7RU UK
| | - Rose Mary Watson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
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Kirton A. Advancing non-invasive neuromodulation clinical trials in children: Lessons from perinatal stroke. Eur J Paediatr Neurol 2017; 21:75-103. [PMID: 27470654 DOI: 10.1016/j.ejpn.2016.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/21/2016] [Accepted: 07/02/2016] [Indexed: 12/18/2022]
Abstract
Applications of non-invasive brain stimulation including therapeutic neuromodulation are expanding at an alarming rate. Increasingly established scientific principles, including directional modulation of well-informed cortical targets, are advancing clinical trial development. However, high levels of disease burden coupled with zealous enthusiasm may be getting ahead of rational research and evidence. Experience is limited in the developing brain where additional issues must be considered. Properly designed and meticulously executed clinical trials are essential and required to advance and optimize the potential of non-invasive neuromodulation without risking the well-being of children and families. Perinatal stroke causes most hemiplegic cerebral palsy and, as a focal injury of defined timing in an otherwise healthy brain, is an ideal human model of developmental plasticity. Advanced models of how the motor systems of young brains develop following early stroke are affording novel windows of opportunity for neuromodulation clinical trials, possibly directing neuroplasticity toward better outcomes. Reviewing the principles of clinical trial design relevant to neuromodulation and using perinatal stroke as a model, this article reviews the current and future issues of advancing such trials in children.
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Affiliation(s)
- Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, 2888 Shaganappi Trail NW, Calgary, AB T3B6A8, Canada.
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Hielkema T, Hadders-Algra M. Motor and cognitive outcome after specific early lesions of the brain - a systematic review. Dev Med Child Neurol 2016; 58 Suppl 4:46-52. [PMID: 27027607 DOI: 10.1111/dmcn.13047] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2015] [Indexed: 11/30/2022]
Abstract
The aim of this systematic review was to study motor and cognitive outcome in infants with severe early brain lesions and to evaluate effects of side of the lesion, sex, and social economic status on outcome. A literature search was performed using the databases Pubmed and Embase. Included studies involved infants with either cystic periventricular leukomalacia (cPVL), preterm, or term stroke (i.e. parenchymal lesion of the brain). Outcome was expressed as cerebral palsy (CP) and intellectual disability (mental retardation). Median prevalence rates of CP after cPVL, preterm, and term stroke were 86%, 71%, and 29% respectively; of intellectual disability 50%, 27%, and 33%. Most infants with cPVL developed bilateral CP, those with term stroke unilateral CP, whereas after preterm stroke bilateral and unilateral CP occurred equally often. Information on the effects of sex and social economic status on outcome after specific brain lesions was very limited. Our findings show that the risk for CP is high after cPVL, moderate after preterm stroke, and lowest after term stroke. The risk for intellectual disability after an early brain lesion is lower than that for CP. Predicting outcome at individual level remains difficult; new imaging techniques may improve predicting developmental trajectories.
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Affiliation(s)
- Tjitske Hielkema
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, the Netherlands
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
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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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Machado V, Pimentel S, Pinto F, Nona J. Perinatal ischemic stroke: a five-year retrospective study in a level-III maternity. EINSTEIN-SAO PAULO 2015; 13:65-71. [PMID: 25993071 PMCID: PMC4946814 DOI: 10.1590/s1679-45082015ao3056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 01/07/2015] [Indexed: 12/04/2022] Open
Abstract
Objective To study the incidence, clinical presentation, risk factors, imaging diagnosis, and clinical outcome of perinatal stroke. Methods Data was retrospectively collected from full-term newborns admitted to the neonatal unit of a level III maternity in Lisbon with cerebral stroke, from January 2007 to December 2011. Results There were 11 cases of stroke: nine were arterial ischemic stroke and two were cerebral venous sinus thrombosis. We estimated an incidence of arterial ischemic stroke of 1.6/5,000 births and of cerebral venous sinus thrombosis of 7.2/100,000 births. There were two cases of recurrent stroke. Eight patients presented with symptoms while the remaining three were asymptomatic and incidentally diagnosed. The most frequently registered symptoms (8/11) were seizures; in that, generalized clonic (3/8) and focal clonic (5/8). Strokes were more commonly left-sided (9/11), and the most affected artery was the left middle cerebral artery (8/11). Transfontanelle ultrasound was positive in most of the patients (10/11), and stroke was confirmed by cerebral magnetic resonance in all patients. Electroencephalographic recordings were carried out in five patients and were abnormal in three (focal abnormalities n=2, burst-suppression pattern n=1). Eight patients had previously identified risk factors for neonatal stroke which included obstetric and neonatal causes. Ten patients were followed up at outpatients setting; four patients developed motor deficits and one presented with epilepsy. Conclusions Although a modest and heterogeneous sample, this study emphasizes the need for a high level of suspicion when it comes to neonatal stroke, primarily in the presence of risk factors. The prevalence of neurological sequelae in our series supports the need of long-term follow-up and early intervention strategies.
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Affiliation(s)
| | | | | | - José Nona
- Maternidade Dr. Alfredo da Costa, Lisboa, Portugal
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40
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Dinomais M, Hertz-Pannier L, Groeschel S, Chabrier S, Delion M, Husson B, Kossorotoff M, Renaud C, Nguyen The Tich S. Long term motor function after neonatal stroke: Lesion localization above all. Hum Brain Mapp 2015; 36:4793-807. [PMID: 26512551 DOI: 10.1002/hbm.22950] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 12/21/2022] Open
Abstract
Motor outcome is variable following neonatal arterial ischemic stroke (NAIS). We analyzed the relationship between lesion characteristics on brain MRI and motor function in children who had suffered from NAIS. Thirty eight full term born children with unilateral NAIS were investigated at the age of seven. 3D T1- and 3D FLAIR-weighted MR images were acquired on a 3T MRI scanner. Lesion characteristics were compared between patients with and without cerebral palsy (CP) using the following approaches: lesion localization either using a category-based analysis, lesion mapping as well as voxel-based lesion-symptom mapping (VLSM). Using diffusion-weighted imaging the microstructure of the cortico-spinal tract (CST) was related to the status of CP by measuring DTI parameters. Whereas children with lesions sparing the primary motor system did not develop CP, CP was always present when extensive lesions damaged at least two brain structures involving the motor system. The VLSM approach provided a statistical map that confirmed the cortical lesions in the primary motor system and revealed that CP was highly correlated with lesions in close proximity to the CST. In children with CP, diffusion parameters indicated microstructural changes in the CST at the level of internal capsule and the centrum semiovale. White matter damage of the CST in centrum semiovale was a highly reproducible marker of CP. This is the first description of the implication of this latter region in motor impairment after NAIS. In conclusion, CP in childhood was closely linked to the location of the infarct in the motor system.
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Affiliation(s)
- Mickael Dinomais
- LUNAM, Université d'Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) - EA7315, F-49000, Angers, France.,LUNAM, CHU Angers, Université d'Angers, Département de Médecine Physique et de Réadaptation, F- 49933, Angers, France
| | - Lucie Hertz-Pannier
- UNIACT, Neurospin, I2BM, DSV, CEA-Saclay, and INSERM U1129 Paris, Université Paris Descartes, Sorbonne Paris Cité, CEA, F-91191, Gif sur Yvette, France
| | - Samuel Groeschel
- Experimental Pediatric Neuroimaging, Department of Pediatric Neurology & Developmental Medicine, University Children's Hospital Tübingen, Germany
| | - Stéphane Chabrier
- CHU Saint-Étienne, Centre national de référence de l'AVC de l'enfant and Inserm CIC1408, F-42055, Saint-Étienne, France.,Université de Saint-x000C9;tienne, Groupe de recherche sur la thrombose - EA3065, F-42023, Saint-Étienne, France
| | - Matthieu Delion
- LUNAM, CHU Angers, Université d'Angers, Département de Neurochirurgie, F-49933, Angers, France.,LUNAM, Université d'Angers, Laboratoire d'Anatomie, Faculté de Médecine F-49045, Angers, France
| | - Béatrice Husson
- Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, Service d'Imagerie Pédiatrique and Centre national de référence de l'AVC de l'enfant, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department and French Center for Pediatric Stroke, University Hospital Necker-Enfants Malades, AP-HP Assistance Publique-Hôpitaux de Paris, F-75743, Paris, France
| | - Cyrille Renaud
- CHU Saint-Étienne, Centre national de référence de l'AVC de l'enfant and Inserm CIC1408, F-42055, Saint-Étienne, France
| | - Sylvie Nguyen The Tich
- LUNAM, Université d'Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) - EA7315, F-49000, Angers, France.,LUNAM, CHU Angers, Université d'Angers, Département de Neuropédiatrie, F-49933, Angers, France
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Abstract
MRI performed in the neonatal period has become a tool widely used by clinicians and researchers to evaluate the developing brain. MRI can provide detailed anatomical resolution, enabling identification of brain injuries due to various perinatal insults. This review will focus on the link between neonatal MRI findings and later neurodevelopmental outcomes in high-risk term infants. In particular, the role of conventional and advanced MR imaging in prognosticating outcomes in neonates with hypoxic-ischemic encephalopathy, ischemic perinatal stroke, need for extracorporeal membrane oxygenation life support, congenital heart disease, and other neonatal neurological conditions will be discussed.
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Affiliation(s)
- An N Massaro
- Department of Pediatrics, The George Washington University School of Medicine, 111 Michigan Ave, NW Washington, DC 20010.
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42
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Chen CY, Tafone S, Lo W, Heathcock JC. Perinatal stroke causes abnormal trajectory and laterality in reaching during early infancy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 38:301-308. [PMID: 25577180 DOI: 10.1016/j.ridd.2014.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 06/04/2023]
Abstract
The developmental progression of reaching and early signs of upper extremity neglect is common concern for infants at risk for hemiparesis and cerebral palsy. We investigated the emergence of reaching and laterality in infants at risk for hemiplegic cerebral palsy. Eight infants with perinatal stroke (PS) and thirteen infants with typical development (TD) were assessed bimonthly from 2 to 7 months of age for 10 visits per infant. Reaching number and hand-toy contact duration were measured. Infants with PS demonstrated a linear trajectory of reaching behaviors with asymmetrical upper extremity performance. Infants with TD demonstrated a linear and quadratic trajectory of reaching behaviors and symmetrical upper extremity performance over the same age range. These results suggest that infants with PS have delay reaching and early signs of neglect not currently accounted for in clinical practice.
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Affiliation(s)
- Chao-Ying Chen
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, United States
| | - Sara Tafone
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, United States
| | - Warren Lo
- Nationwide Children's Hospital, Department of Neurology, United States
| | - Jill C Heathcock
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, United States; Nationwide Children's Hospital, Center for Perinatal Research, United States.
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43
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Goldenberg NA, Everett AD, Graham D, Bernard TJ, Nowak-Göttl U. Proteomic and other mass spectrometry based “omics” biomarker discovery and validation in pediatric venous thromboembolism and arterial ischemic stroke: Current state, unmet needs, and future directions. Proteomics Clin Appl 2014; 8:828-36. [DOI: 10.1002/prca.201400062] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/06/2014] [Accepted: 11/03/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Neil A. Goldenberg
- Clinical and Translational Research Organization; All Children's Research Institute; All Children's Hospital Johns Hopkins Medicine; St. Petersburg FL USA
- Johns Hopkins Medicine Pediatric Thrombosis Program; All Children's Hospital Johns Hopkins Medicine; St. Petersburg FL, USA and Johns Hopkins Bloomberg Children's Center, Baltimore, MD, USA
- Johns Hopkins Medicine Pediatric Stroke Program; All Children's Hospital Johns Hopkins Medicine; St. Petersburg FL USA and Johns Hopkins Children's Center, Baltimore, MD, USA
- Division of Hematology; Department of Pediatrics; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Allen D. Everett
- Division of Cardiology; Johns Hopkins University School of Medicine; Baltimore MD USA
- Pediatric Proteome Center; Department of Pediatrics; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - David Graham
- Department of Molecular and Comparative Pathobiology; Johns Hopkins University; Baltimore MD USA
- Center for Resources in Integrative Biology; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Timothy J. Bernard
- Department of Pediatrics; Denver School of Medicine; University of Colorado; Aurora CO USA
- Pediatric Stroke Program; Children's Hospital Colorado; Aurora CO USA
| | - Ulrike Nowak-Göttl
- Department of Pediatrics; Universitätsklinikum Schleswig-Holstein; Kiel Germany
- Department of Medicine; Universitätsklinikum Schleswig-Holstein; Kiel Germany
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Lehman LL, Rivkin MJ. Perinatal arterial ischemic stroke: presentation, risk factors, evaluation, and outcome. Pediatr Neurol 2014; 51:760-8. [PMID: 25444092 DOI: 10.1016/j.pediatrneurol.2014.07.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Perinatal arterial ischemic stroke is as common as large vessel arterial ischemic stroke in adults and leads to significant morbidity. Perinatal arterial ischemic stroke is the most common identifiable cause of cerebral palsy and can lead to cognitive and behavioral difficulties that are amortized over a lifetime. METHODS The literature on perinatal arterial ischemic stroke was reviewed and analyzed. RESULTS Risk factors for perinatal arterial ischemic stroke include those that are maternal, neonatal, and placental. The most common clinical signs at presentation are seizures and hemiparesis. Evaluation should begin with thorough history acquisition and physical examination followed by magnetic resonance imaging of the brain, with consideration of magnetic resonance angiography of the head and neck, echocardiogram, and thrombophilia evaluation. Treatment beginning early to include physical, speech, and occupational therapies including constraint-induced movement therapy and close cognitive and developmental follow-up may be beneficial. Future treatments may include transcranial magnetic stimulation, hypothermia, and erythropoietin. CONCLUSIONS Perinatal arterial ischemic stroke comprises a group of arterial ischemic injuries that can occur in the prenatal, perinatal, and postnatal periods in term and preterm infants with different types of perinatal arterial ischemic stroke having different clinical presentations, risk factors, and long-term outcomes.
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Affiliation(s)
- Laura L Lehman
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Michael J Rivkin
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; Department of and Radiology, Boston Children's Hospital, Boston, Massachusetts.
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Basu AP. Early intervention after perinatal stroke: opportunities and challenges. Dev Med Child Neurol 2014; 56:516-21. [PMID: 24528276 PMCID: PMC4020312 DOI: 10.1111/dmcn.12407] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2014] [Indexed: 12/16/2022]
Abstract
Perinatal stroke is the most common cause of hemiplegic cerebral palsy. No standardized early intervention exists despite evidence for a critical time window for activity-dependent plasticity to mould corticospinal tract development in the first few years of life. Intervention during this unique period of plasticity could mitigate the consequences of perinatal stroke to an extent not possible with later intervention, by preserving the normal pattern of development of descending motor pathways. This article outlines the broad range of approaches currently under investigation. Despite significant progress in this area, improved early detection and outcome prediction remain important goals.
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Affiliation(s)
- Anna P Basu
- NIHR Clinical Trials Fellow, Newcastle upon Tyne Hospitals NHS Foundation Trust. Level 3, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
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Mechanisms of perinatal arterial ischemic stroke. J Cereb Blood Flow Metab 2014; 34:921-32. [PMID: 24667913 PMCID: PMC4050239 DOI: 10.1038/jcbfm.2014.41] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 12/30/2013] [Accepted: 01/02/2014] [Indexed: 01/21/2023]
Abstract
The incidence of perinatal stroke is high, similar to that in the elderly, and produces a significant morbidity and severe long-term neurologic and cognitive deficits, including cerebral palsy, epilepsy, neuropsychological impairments, and behavioral disorders. Emerging clinical data and data from experimental models of cerebral ischemia in neonatal rodents have shown that the pathophysiology of perinatal brain damage is multifactorial. These studies have revealed that, far from just being a smaller version of the adult brain, the neonatal brain is unique with a very particular and age-dependent responsiveness to hypoxia-ischemia and focal arterial stroke. In this review, we discuss fundamental clinical aspects of perinatal stroke as well as some of the most recent and relevant findings regarding the susceptibility of specific brain cell populations to injury, the dynamics and the mechanisms of neuronal cell death in injured neonates, the responses of neonatal blood-brain barrier to stroke in relation to systemic and local inflammation, and the long-term effects of stroke on angiogenesis and neurogenesis. Finally, we address translational strategies currently being considered for neonatal stroke as well as treatments that might effectively enhance repair later after injury.
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Gordon AL. Functioning and disability after stroke in children: using the ICF-CY to classify health outcome and inform future clinical research priorities. Dev Med Child Neurol 2014; 56:434-44. [PMID: 24341384 DOI: 10.1111/dmcn.12336] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 11/29/2022]
Abstract
AIM The International Classification of Functioning Disability and Health, Child-Youth version (ICF-CY) provides a framework for describing and evaluating health, intervention outcomes, and needs assessment. It can, however, also serve as a system for classifying the focus of outcome studies and identification of gaps in current knowledge. METHOD The paediatric arterial ischaemic stroke (AIS) population was targeted. Multiple databases were systematically searched for AIS outcome studies focussing on functioning or disability. Findings were rated using the ICF-CY framework. RESULTS Twenty-eight studies were identified. Most were cross-sectional and age range at assessment varied widely. Sixty-seven different standardized measures were used, predominantly evaluating body functions. The most common domains of activity and participation reported were learning and applying knowledge, general tasks and demands, and self-care skills. Health-related quality of life was measured in nine papers. Environmental factors were rarely evaluated. INTERPRETATION AIS outcome studies addressing the relationship between body structures and functions (e.g. brain lesion characteristics, neurological examination findings) and activities, participation, and quality of life have emerged in recent years. Comparison of findings across studies is complicated by design and tool selection. The relationship between components of activity limitation and participation restriction is rarely explored.
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Affiliation(s)
- Anne L Gordon
- Paediatric Neurosciences Department, Evelina London Children's Hospital, Guy's & St Thomas' Hospital NHS Foundation Trust, Kings Health Partners, London, UK; Clinical Sciences Theme, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
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Guzmán-Pruneda FA, Fraser CD. Neuroprotective strategies--what do we really need to know? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2014; 17:77-80. [PMID: 24725721 DOI: 10.1053/j.pcsu.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
While preliminary data are encouraging, definitive data are lacking to conclusively demonstrate the benefit of perioperative neurologic monitoring in improving neurodevelopmental outcomes in children who require surgery for congenital heart disease. Nonetheless, in the current era, some form of perioperative neurologic monitoring is important. Strategies include bicortical near infrared spectroscopy monitoring in the pre- and postoperative periods along with bicortical near infrared spectroscopy and transcranial Doppler intraoperatively. These monitors provide real-time information concerning cerebral oxygen delivery and blood flow. These strategies will allow us to refine treatments to optimize neurodevelopmental potential in children with congenital heart disease.
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Affiliation(s)
- Francisco A Guzmán-Pruneda
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Charles D Fraser
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
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van der Aa NE, Benders MJNL, Groenendaal F, de Vries LS. Neonatal stroke: a review of the current evidence on epidemiology, pathogenesis, diagnostics and therapeutic options. Acta Paediatr 2014; 103:356-64. [PMID: 24428836 DOI: 10.1111/apa.12555] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/02/2014] [Accepted: 01/10/2014] [Indexed: 12/26/2022]
Abstract
UNLABELLED Neonatal stroke, including perinatal arterial ischaemic stroke and cerebral sinovenous thrombosis, remains a serious problem in the neonate. This article reviews the current evidence on epidemiology, pathogenesis, diagnostics and therapeutic options. CONCLUSION Although our understanding of the underlying mechanisms and possible risk factors has improved, little progress has been made towards therapeutic options. Considering the high incidence of neurological sequelae, the need for therapeutic options is high and should be the focus of future research.
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Affiliation(s)
- NE van der Aa
- Department of Neonatology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - MJNL Benders
- Department of Neonatology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - F Groenendaal
- Department of Neonatology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - LS de Vries
- Department of Neonatology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
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Behavioral and histological outcomes following neonatal HI injury in a preterm (P3) and term (P7) rodent model. Behav Brain Res 2013; 259:85-96. [PMID: 24185032 DOI: 10.1016/j.bbr.2013.10.038] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/15/2013] [Accepted: 10/24/2013] [Indexed: 11/22/2022]
Abstract
Hypoxia-ischemia (HI) occurs when blood and/or oxygen delivery to the brain is compromised. HI injuries can occur in infants born prematurely (<37 weeks gestational age) or at very low birth weight (<1500 g), as well as in term infants with birth complications. In both preterm and term HI populations, brain injury is associated with subsequent behavioral deficits. Neonatal HI injury can be modeled in rodents (e.g., the Rice-Vannucci method, via cautery of right carotid followed by hypoxia). When this injury is induced early in life (between postnatal day (P)1-5), neuropathologies typical of human preterm HI are modeled. When injury is induced later (P7-12), neuropathologies typical of those seen in HI term infants are modeled. The current study sought to characterize the similarities/differences between outcomes following early (P3) and late (P7) HI injury in rats. Male rats with HI injury on P3 or P7, as well as sham controls, were tested on a variety of behavioral tasks in both juvenile and adult periods. Results showed that P7 HI rats displayed deficits on motor learning, rapid auditory processing (RAP), and other learning/memory tasks, as well as a reduction in volume in various neuroanatomical structures. P3 HI animals showed only transient deficits on RAP tasks in the juvenile period (but not in adulthood), yet robust deficits on a visual attention task in adulthood. P3 HI animals did not show any significant reductions in brain volume that we could detect. These data suggest that: (1) behavioral deficits following neonatal HI are task-specific depending on timing of injury; (2) P3 HI rats showed transient deficits on RAP tasks; (3) the more pervasive behavioral deficits seen following P7 HI injury were associated with substantial global tissue loss; and (4) persistent deficits in attention in P3 HI subjects might be linked to neural connectivity disturbances rather than a global loss of brain volume, given that no such pathology was found. These combined findings can be applied to our understanding of differing long-term outcomes following neonatal HI injury in premature versus term infants.
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