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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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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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Cappellari AM, Palumbo S, Margiotta S. Questions and Controversies in Neonatal Seizures. CHILDREN (BASEL, SWITZERLAND) 2023; 11:40. [PMID: 38255354 PMCID: PMC10814600 DOI: 10.3390/children11010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Neonatal seizures are relatively common, but their diagnosis and management remain challenging. We reviewed the scientific literature on neonatal seizures from July 1973 to November 2023. Several parameters were considered, including pathophysiology, diagnostic criteria, electroencephalographic findings and treatment. Recent classification system of seizures and epilepsies in the newborn, as well as treatment recommendations of neonatal seizures, have been proposed. Nonetheless, the approach to neonatal seizures varies among clinicians and centres, including detection, investigation, treatment and follow-up of patients. There are still many issues on the diagnosis and treatment of neonatal seizures, including the meaning or relevance of some electroencephalographic findings, the precise estimation of the seizure burden, the limited efficacy and side effects risk of antiseizure medications, and the best measures to establish the outcome.
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Affiliation(s)
- Alberto M. Cappellari
- Department of Neuroscience and Mental Health, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milano, Italy
| | - Sarah Palumbo
- Postgraduate School of Paediatrics, Department of Pediatrics, University of Milan, 20122 Milano, Italy; (S.P.); (S.M.)
| | - Stefania Margiotta
- Postgraduate School of Paediatrics, Department of Pediatrics, University of Milan, 20122 Milano, Italy; (S.P.); (S.M.)
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Vaher U, Ilves N, Ilves N, Laugesaar R, Männamaa M, Loorits D, Kool P, Ilves P. The thalamus and basal ganglia are smaller in children with epilepsy after perinatal stroke. Front Neurol 2023; 14:1252472. [PMID: 37840930 PMCID: PMC10568465 DOI: 10.3389/fneur.2023.1252472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Background Epilepsy is one of the most serious consequences of perinatal stroke. Epilepsy itself has been proposed as a risk factor for impaired cognitive, language, and behavioral functioning. It is still unclear which children develop epilepsy after perinatal stroke. The current study aimed to evaluate the volume of the thalamus and the basal ganglia in children after perinatal stroke in relation to poststroke epilepsy. Methods The follow-up study included 29 children with perinatal arterial ischemic stroke (AIS), 33 children with presumed periventricular venous infarction (PVI), and 46 age- and sex-matched healthy controls. Magnetic resonance imaging was performed in children between the ages of 4 and 18 years, and volumetric analysis by segmentation was used to evaluate the size of the thalamus, caudate nucleus, putamen, globus pallidus, hippocampus, amygdala, and nucleus accumbens. Results During a median follow-up time of 12.8 years [interquartile range (IQR): 10.8-17.3] in the AIS group and 12.5 years (IQR: 9.3-14.8) in the PVI group (p = 0.32), epilepsy developed in 10 children (34.5%) with AIS and in 4 (12.1%) children with PVI, p = 0.036 [odds ratio (OR) = 3.8, 95%, confidence interval (CI): 1.04-14]. Epilepsy and interictal epileptiform discharges (IEDs) without clinical seizures were more often expressed in children with AIS (n = 16, 55%) than in children with PVI (n = 7, 21.2%), p = 0.0057 (OR = 3.8 95% CI: 1.04-14). In the AIS group, the ipsilesional and contralesional thalamus, ipsilesional caudate nucleus, and nucleus accumbens were significantly smaller in children with epilepsy compared to children without epilepsy. In the PVI group, the ipsilesional thalamus, caudate nucleus, and nucleus accumbens were smaller in the pooled group of epilepsy plus IED alone compared to children without epilepsy. Conclusion In children with AIS, epilepsy or IED occurred more often compared to children with PVI. Both patients with AIS and PVI with severe damage to the basal ganglia and the thalamus have a higher risk of developing poststroke epilepsy and should be monitored more closely throughout childhood to initiate timely antiseizure medication and rehabilitation.
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Affiliation(s)
- Ulvi Vaher
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Norman Ilves
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Nigul Ilves
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Rael Laugesaar
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Pediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Mairi Männamaa
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Dagmar Loorits
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Pille Kool
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Pilvi Ilves
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
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Rees P, Callan C, Chadda K, Vaal M, Diviney J, Sabti S, Harnden F, Gardiner J, Battersby C, Gale C, Sutcliffe A. School-age outcomes of children after perinatal brain injury: a systematic review and meta-analysis. BMJ Paediatr Open 2023; 7:e001810. [PMID: 37270200 PMCID: PMC10255042 DOI: 10.1136/bmjpo-2022-001810] [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: 12/06/2022] [Accepted: 02/14/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Over 3000 children suffer a perinatal brain injury in England every year according to national surveillance. The childhood outcomes of infants with perinatal brain injury are however unknown. METHODS A systematic review and meta-analyses were undertaken of studies published between 2000 and September 2021 exploring school-aged neurodevelopmental outcomes of children after perinatal brain injury compared with those without perinatal brain injury. The primary outcome was neurodevelopmental impairment, which included cognitive, motor, speech and language, behavioural, hearing or visual impairment after 5 years of age. RESULTS This review included 42 studies. Preterm infants with intraventricular haemorrhage (IVH) grades 3-4 were found to have a threefold greater risk of moderate-to-severe neurodevelopmental impairment at school age OR 3.69 (95% CI 1.7 to 7.98) compared with preterm infants without IVH. Infants with perinatal stroke had an increased incidence of hemiplegia 61% (95% CI 39.2% to 82.9%) and an increased risk of cognitive impairment (difference in full scale IQ -24.2 (95% CI -30.73 to -17.67) . Perinatal stroke was also associated with poorer academic performance; and lower mean receptive -20.88 (95% CI -36.66 to -5.11) and expressive language scores -20.25 (95% CI -34.36 to -6.13) on the Clinical Evaluation of Language Fundamentals (CELF) assessment. Studies reported an increased risk of persisting neurodevelopmental impairment at school age after neonatal meningitis. Cognitive impairment and special educational needs were highlighted after moderate-to-severe hypoxic-ischaemic encephalopathy. However, there were limited comparative studies providing school-aged outcome data across neurodevelopmental domains and few provided adjusted data. Findings were further limited by the heterogeneity of studies. CONCLUSIONS Longitudinal population studies exploring childhood outcomes after perinatal brain injury are urgently needed to better enable clinicians to prepare affected families, and to facilitate targeted developmental support to help affected children reach their full potential.
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Affiliation(s)
- Philippa Rees
- Population Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Caitriona Callan
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karan Chadda
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Meriel Vaal
- Population Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - James Diviney
- Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Fergus Harnden
- Neonatal Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Julian Gardiner
- Population Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Alastair Sutcliffe
- Population Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
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Trowbridge SK, Condie LO, Landers JR, Bergin AM, Grant PE, Krishnamoorthy K, Rofeberg V, Wypij D, Staley KJ, Soul JS. Effect of neonatal seizure burden and etiology on the long-term outcome: data from a randomized, controlled trial. ANNALS OF THE CHILD NEUROLOGY SOCIETY 2023; 1:53-65. [PMID: 37636014 PMCID: PMC10449023 DOI: 10.1002/cns3.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/11/2022] [Indexed: 08/29/2023]
Abstract
Background Neonatal seizures are common, but the impact of neonatal seizures on long-term neurologic outcome remains unclear. We addressed this question by analyzing data from an early-phase controlled trial of bumetanide to treat neonatal seizures. Methods Neonatal seizure burden was calculated from continuous video-EEG data. Neurologic outcome was determined by standardized developmental tests and post-neonatal seizure recurrence. Results Of 111 enrolled neonates, 43 were randomized to treatment or control groups. There were no differences in neurologic outcome between treatment and control groups. A subgroup analysis was performed for 84 neonates with acute perinatal brain injury (57 HIE, 18 stroke, 9 ICH), most of whom (70%) had neonatal seizures. There was a significant negative correlation between seizure burden and developmental scores (p<0.01). Associations between seizure burden and developmental scores were stronger in HIE and stroke groups compared with ICH (p<0.05). Conclusion Bumetanide showed no long-term beneficial or adverse effects, as expected based on treatment duration versus duration of neonatal seizures. For neonates with perinatal brain injury, higher neonatal seizure burden correlated significantly with worse developmental outcome, particularly for ischemic versus hemorrhagic brain injury. These data highlight the need for further investigation of the long-term effects of both neonatal seizure severity and etiology.
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Affiliation(s)
- Sara K. Trowbridge
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Lois O. Condie
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Jessica R. Landers
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Ann M. Bergin
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Patricia E. Grant
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
- Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | | | - Valerie Rofeberg
- Department of Cardiology, Boston Children’s Hospital, Boston, MA
| | - David Wypij
- Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kevin J. Staley
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Janet S. Soul
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1433] [Impact Index Per Article: 1433.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Lesion size and long-term cognitive outcome after pediatric stroke: A comparison between two techniques to assess lesion size. Eur J Paediatr Neurol 2023; 42:126-132. [PMID: 36641854 DOI: 10.1016/j.ejpn.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/25/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is little consensus on how lesion size impacts long-term cognitive outcome after pediatric arterial ischemic stroke (AIS). This study, therefore, compared two techniques to assessed lesion size in the chronic phase after AIS and determined their measurement agreement in relation to cognitive functions in patients after pediatric stroke. METHODS Twenty-five patients after pediatric AIS were examined in the chronic phase (>2 years after stroke) in respect to intelligence, memory, executive functions, visuo-motor functions, motor abilities, and disease-specific outcome. Lesion size was measured using the ABC/2 formula and segmentation technique (3D Slicer). Correlation analysis determined the association between volumetry techniques and outcome measures in respect to long-term cognitive outcome. RESULTS The measurements from the ABC/2 and segmentation technique were strongly correlated (r = 0.878, p < .001) and displayed agreement in particular for small lesions. Lesion size from both techniques was significantly correlated with disease-specific outcome (p < .001) and processing speed (p < .005) after controlling for age at stroke and multiple comparison. CONCLUSION The two techniques showed convergent validity and were both significantly correlated with long-term outcome after pediatric AIS. Compared to the time-consuming segmentation technique, ABC/2 facilitates clinical and research work as it requires relatively little time and is easy to apply.
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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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He Y, Ying J, Tang J, Zhou R, Qu H, Qu Y, Mu D. Neonatal Arterial Ischaemic Stroke: Advances in Pathologic Neural Death, Diagnosis, Treatment, and Prognosis. Curr Neuropharmacol 2022; 20:2248-2266. [PMID: 35193484 PMCID: PMC9890291 DOI: 10.2174/1570159x20666220222144744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/04/2022] [Accepted: 02/18/2022] [Indexed: 12/29/2022] Open
Abstract
Neonatal arterial ischaemic stroke (NAIS) is caused by focal arterial occlusion and often leads to severe neurological sequelae. Neural deaths after NAIS mainly include necrosis, apoptosis, necroptosis, autophagy, ferroptosis, and pyroptosis. These neural deaths are mainly caused by upstream stimulations, including excitotoxicity, oxidative stress, inflammation, and death receptor pathways. The current clinical approaches to managing NAIS mainly focus on supportive treatments, including seizure control and anticoagulation. In recent years, research on the pathology, early diagnosis, and potential therapeutic targets of NAIS has progressed. In this review, we summarise the latest progress of research on the pathology, diagnosis, treatment, and prognosis of NAIS and highlight newly potential diagnostic and treatment approaches.
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Affiliation(s)
- Yang He
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Junjie Ying
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Ruixi Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Haibo Qu
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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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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Perrone S, Lembo C, Gironi F, Petrolini C, Catalucci T, Corbo G, Buonocore G, Gitto E, Esposito SMR. Erythropoietin as a Neuroprotective Drug for Newborn Infants: Ten Years after the First Use. Antioxidants (Basel) 2022; 11:antiox11040652. [PMID: 35453337 PMCID: PMC9031072 DOI: 10.3390/antiox11040652] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 01/27/2023] Open
Abstract
Protective strategies against perinatal brain injury represent a major challenge for modern neonatology. Erythropoietin (Epo) enhances endogenous mechanisms of repair and angiogenesis. In order to analyse the newest evidence on the role of Epo in prematurity, hypoxic ischemic encephalopathy (HIE) and perinatal stroke, a critical review using 2020 PRISMA statement guidelines was conducted. This review uncovered 26 clinical trials examining the use of Epo for prematurity and brain injury-related outcomes. The effects of Epo on prematurity were analysed in 16 clinical trials. Erythropoietin was provided until 32–35 weeks of corrected postnatal age with a dosage between 500–3000 UI/kg/dose. Eight trials reported the Epo effects on HIE term newborn infants: Erythropoietin was administered in the first weeks of life, at different multiple doses between 250–2500 UI/kg/dose, as either an adjuvant therapy with hypothermia or a substitute for hypothermia. Two trials investigated Epo effects in perinatal stroke. Erythropoietin was administered at a dose of 1000 IU/kg for three days. No beneficial effect in improving morbidity was observed after Epo administration in perinatal stroke. A positive effect on neurodevelopmental outcome seems to occur when Epo is used as an adjuvant therapy with hypothermia in the HIE newborns. Administration of Epo in preterm infants still presents inconsistencies with regard to neurodevelopmental outcome. Clinical trials show significant differences mainly in target population and intervention scheme. The identification of specific markers and their temporal expression at different time of recovery after hypoxia-ischemia in neonates might be implemented to optimize the therapeutic scheme after hypoxic-ischemic injury in the developing brain. Additional studies on tailored regimes, accounting for the risk stratification of brain damage in newborns, are required.
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Affiliation(s)
- Serafina Perrone
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (C.P.); (S.M.R.E.)
- Correspondence:
| | - Chiara Lembo
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (C.L.); (F.G.); (T.C.); (G.C.); (G.B.)
| | - Federica Gironi
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (C.L.); (F.G.); (T.C.); (G.C.); (G.B.)
| | - Chiara Petrolini
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (C.P.); (S.M.R.E.)
| | - Tiziana Catalucci
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (C.L.); (F.G.); (T.C.); (G.C.); (G.B.)
| | - Giulia Corbo
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (C.L.); (F.G.); (T.C.); (G.C.); (G.B.)
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (C.L.); (F.G.); (T.C.); (G.C.); (G.B.)
| | - Eloisa Gitto
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy;
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2610] [Impact Index Per Article: 1305.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Lee S, Fox CK. Modified Pediatric ASPECTS: Building Tools for Future Pediatric Stroke Studies. Neurology 2021; 97:570-571. [PMID: 34389647 DOI: 10.1212/wnl.0000000000012543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sarah Lee
- From the Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; and Departments of Neurology and Pediatrics (C.K.F.), University of California San Francisco
| | - Christine K Fox
- From the Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; and Departments of Neurology and Pediatrics (C.K.F.), University of California San Francisco.
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Beslow LA, Vossough A, Ichord RN, Slavova N, Yau MLY, Gajera J, Stojanovski B, Adil MM, Breimann J, Kimmel A, Mackay MT. Association of Pediatric ASPECTS and NIH Stroke Scale, Hemorrhagic Transformation, and 12-Month Outcome in Children With Acute Ischemic Stroke. Neurology 2021; 97:e1202-e1209. [PMID: 34389646 DOI: 10.1212/wnl.0000000000012558] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to determine whether a modified pediatric Alberta Stroke Program Early CT Score (modASPECTS) is associated with clinical stroke severity, hemorrhagic transformation, and 12-month functional outcomes in children with acute arterial ischemic stroke (AIS). METHODS Children (age 29 days-<18 years) with acute AIS enrolled in 2 institutional prospective stroke registries at the Children's Hospital of Philadelphia and Royal Children's Hospital Melbourne, Australia were retrospectively analyzed to determine whether modASPECTS, in which higher scores are worse, correlated with acute pediatric NIH Stroke Scale (PedNIHSS) scores (children ≥2 years of age), was associated with hemorrhagic transformation on acute MRI, and correlated with 12-month functional outcome on the Pediatric Stroke Outcome Measure. RESULTS One hundred thirty-one children were included; 91 were ≥2 years of age. Median time from stroke to MRI was 1 day (interquartile range [IQR] 0-1 day). Median modASPECTS was 4 (IQR 3-7). ModASPECTS correlated with PedNIHSS score (ρ = 0.40, p = 0.0001). ModASPECTS was associated with hemorrhagic transformation (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.02-1.25, p = 0.018). Among children with follow-up (n = 128, median 12.2 months, IQR 9.5-15.4 months), worse outcomes were associated with higher modASPECTS (common OR 1.14, 95% CI 1.04-1.24, p = 0.005). The association between modASPECTS and outcome persisted when we adjusted for age at stroke ictus and the presence of tumor or meningitis as stroke risk factors (common OR 1.14, 95% CI 1.03-1.25, p = 0.008). DISCUSSION ModASPECTS correlates with PedNIHSS scores, hemorrhagic transformation, and 12-month functional outcome in children with acute AIS. Future pediatric studies should evaluate its usefulness in predicting symptomatic intracranial hemorrhage and outcome after acute revascularization therapies. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the modASPECTS on MRI is associated with stroke severity (as measured by the baseline PedNIHSS score), hemorrhagic transformation, and 12-month outcome in children with acute supratentorial ischemic stroke.
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Affiliation(s)
- Lauren A Beslow
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia.
| | - Arastoo Vossough
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Rebecca N Ichord
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Nedelina Slavova
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Maggie L Y Yau
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Jay Gajera
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Belinda Stojanovski
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Malik M Adil
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Jake Breimann
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Alexandra Kimmel
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
| | - Mark T Mackay
- From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia
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Tetsuhara K, Kaku N, Watanabe Y, Kumamoto M, Ichimiya Y, Mizuguchi S, Higashi K, Matsuoka W, Motomura Y, Sanefuji M, Hiwatashi A, Sakai Y, Ohga S. Predictive values of early head computed tomography for survival outcome after cardiac arrest in childhood: a pilot study. Sci Rep 2021; 11:12090. [PMID: 34103642 PMCID: PMC8187472 DOI: 10.1038/s41598-021-91628-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/28/2021] [Indexed: 12/17/2022] Open
Abstract
Predicting outcomes of children after cardiac arrest (CA) remains challenging. To identify useful prognostic markers for pediatric CA, we retrospectively analyzed the early findings of head computed tomography (CT) of patients. Subjects were non-traumatic, out-of-hospital CA patients < 16 years of age who underwent the first head CT within 24 h in our institute from 2006 to 2018 (n = 70, median age: 4 months, range 0–163). Of the 24 patients with return of spontaneous circulation, 14 survived up to 30 days after CA. The degree of brain damage was quantitatively measured with modified methods of the Alberta Stroke Program Early CT Score (mASPECTS) and simplified gray-matter-attenuation-to-white-matter-attenuation ratio (sGWR). The 14 survivors showed higher mASPECTS values than the 56 non-survivors (p = 0.035). All 3 patients with mASPECTS scores ≥ 20 survived, while an sGWR ≥ 1.14 indicated a higher chance of survival than an sGWR < 1.14 (54.5% vs. 13.6%). Follow-up magnetic resonance imaging for survivors validated the correlation of the mASPECTS < 15 with severe brain damage. Thus, low mASPECTS scores were associated with unfavorable neurological outcomes on the Pediatric Cerebral Performance Category scale. A quantitative analysis of early head CT findings might provide clues for predicting survival of pediatric CA.
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Affiliation(s)
- Kenichi Tetsuhara
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Noriyuki Kaku
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan.
| | - Yuka Watanabe
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaya Kumamoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuko Ichimiya
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Soichi Mizuguchi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kanako Higashi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Wakato Matsuoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Yoshitomo Motomura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Sanefuji
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akio Hiwatashi
- Department of Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Srivastava R, Shaw OEF, Armstrong E, Morneau-Jacob FD, Yager JY. Patterns of Brain Injury in Perinatal Arterial Ischemic Stroke and the Development of Infantile Spasms. J Child Neurol 2021; 36:583-588. [PMID: 33543672 DOI: 10.1177/0883073820986056] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Perinatal arterial ischemic stroke (PAIS) underlies approximately 10% of infantile spasms (IS). We aim to identify patterns of brain injury in ischemic stroke that may predispose infants to infantile spasms. METHODS Sixty-four perinatal arterial ischemic stroke patients were identified meeting the following inclusion criteria: term birth, magnetic resonance imaging (MRI) showing ischemic stroke or encephalomalacia in an arterial distribution, and follow-up records. Patients who developed infantile spasms (PAIS-IS) were analyzed descriptively for ischemic stroke injury patterns and were compared to a seizure-free control group (PAIS-only). Stroke injury was scored using the modified pediatric ASPECTS (modASPECTS). RESULTS The PAIS-IS (n = 9) group had significantly higher modASPECTS than the PAIS-only (n = 16) group (P = .002, Mann-Whitney). A greater proportion of PAIS-IS patients had injury to deep cerebral structures (67%) than PAIS-only (25%). CONCLUSION Infarct size was significantly associated with infantile spasms development. Results support theories implicating deep cerebral structures in infantile spasms pathogenesis. This may help identify perinatal arterial ischemic stroke patients at risk of infantile spasms, facilitating more timely diagnosis.
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Affiliation(s)
- Ratika Srivastava
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, 25484University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
| | - Oriana E F Shaw
- Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
| | - Edward Armstrong
- Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
| | - Francois-Dominique Morneau-Jacob
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, 25484University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Y Yager
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, 25484University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
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Short-term outcomes after a neonatal arterial ischemic stroke. Childs Nerv Syst 2021; 37:1249-1254. [PMID: 33064213 DOI: 10.1007/s00381-020-04931-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study is to determine the frequency and radiological predictors of recurrent acute symptomatic seizures (RASS) and motor impairment at discharge after a neonatal arterial ischemic stroke (NAIS). METHODS In a nonconcurrent cohort study, 33 full-term newborns with NAIS confirmed by MRI are admitted into our hospital between January 2003 and December 2012. Stroke size, calculated as stroke volume divided by whole brain volume (WBV), was categorized as > or < 3.3% of WBV. A univariate analysis of categorical variables was performed using Fisher's exact test. A multivariate analysis was performed using logistic regression models including all variables with a p value < 0.1 in the univariate analysis. RESULTS The median age at NAIS was 2 days (IQR, 1-5.6), 36.4% were girls. The stroke size was > 3.3 of WBV in 48.5% of the cases, and 54.5% showed multifocal lesions. Involvement of the cerebral cortex (54.5%), thalamus (48.5%), posterior limb of the internal capsule (36.4%), basal ganglia (36.4%), and brainstem (28.2%) were found. At discharge, 45.5% of newborns had a motor deficit, and 27.3% had at least two seizures. Multivariate analyses revealed that stroke size > 3.3% of WBV (OR: 8.1, CI: 1.2-53.9) and basal ganglia involvement (OR: 12.8, CI: 1.7-95.4) predicted motor impairment at discharge. Cortical involvement of temporal and frontal lobes (OR: 14, CI: 2.2-88.1; and OR: 9.1, CI: 1.2-72.6) were predictive of RASS. CONCLUSION Stroke size and location are independent risk factors for adverse short-term neurological outcomes in full-term newborns following a NAIS.
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Srivastava R, Kirton A. Perinatal Stroke: A Practical Approach to Diagnosis and Management. Neoreviews 2021; 22:e163-e176. [PMID: 33649089 DOI: 10.1542/neo.22-3-e163] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Perinatal stroke is a focal vascular brain injury that occurs from the fetal period to 28 days of postnatal age. With an overall incidence of up to 1 in 1,000 live births, the most focused lifetime risk for stroke occurs near birth. Perinatal stroke can be classified by the timing of diagnosis, vessel involvement, and type of injury. Timing of diagnosis may be in the acute neonatal period or retrospectively after a period of normal development, followed by abnormal neurologic findings, with the injury presumed to have occurred around the time of birth. Strokes may be arterial or venous, ischemic, and/or hemorrhagic. Within these classifications, 6 perinatal stroke diseases are recognizable, based on clinical and radiographic features. Morbidity is high in perinatal stroke, because it accounts for most cases of hemiparetic cerebral palsy, with disability lasting a lifetime. Additional complications include disorders of sensation and vision, language delays, cognitive and learning deficits, epilepsy, and mental health consequences that affect the entire family. Advances in neonatal neurocritical care may afford opportunity to minimize brain injury and improve outcomes. In the chronic timeframe, progress made in neuroimaging and brain mapping is revealing the developmental plasticity that occurs, informing new avenues for neurorehabilitation. This review will summarize the diagnosis and management of each perinatal stroke disease, highlighting their similarities and distinctions and emphasizing a patient- and family-centered approach to management.
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Affiliation(s)
- Ratika Srivastava
- Department of Community Health Sciences.,Department of Pediatrics, Section of Neurology; and.,Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada
| | - Adam Kirton
- Department of Pediatrics, Section of Neurology; and.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada
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21
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3172] [Impact Index Per Article: 1057.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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22
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Kirschen MP, Licht DJ, Faerber J, Mondal A, Graham K, Winters M, Balu R, Diaz-Arrastia R, Berg RA, Topjian A, Vossough A. Association of MRI Brain Injury With Outcome After Pediatric Out-of-Hospital Cardiac Arrest. Neurology 2020; 96:e719-e731. [PMID: 33208547 DOI: 10.1212/wnl.0000000000011217] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine the association between the extent of diffusion restriction and T2/fluid-attenuated inversion recovery (FLAIR) injury on brain MRI and outcomes after pediatric out-of-hospital cardiac arrest (OHCA). METHODS Diffusion restriction and T2/FLAIR injury were described according to the pediatric MRI modification of the Alberta Stroke Program Early Computed Tomography Score (modsASPECTS) for children from 2005 to 2013 who had an MRI within 14 days of OHCA. The primary outcome was unfavorable neurologic outcome defined as ≥1 change in Pediatric Cerebral Performance Category (PCPC) from baseline resulting in a hospital discharge PCPC score 3, 4, 5, or 6. Patients with unfavorable outcomes were further categorized into alive with PCPC 3-5, dead due to withdrawal of life-sustaining therapies for poor neurologic prognosis (WLST-neuro), or dead by neurologic criteria. RESULTS We evaluated MRI scans from 77 patients (median age 2.21 [interquartile range 0.44, 13.07] years) performed 4 (2, 6) days postarrest. Patients with unfavorable outcomes had more extensive diffusion restriction (median 7 [4, 10.3] vs 0 [0, 0] regions, p < 0.001) and T2/FLAIR injury (5.5 [2.3, 8.2] vs 0 [0, 0.75] regions, p < 0.001) compared to patients with favorable outcomes. Area under the receiver operating characteristic curve for the extent of diffusion restriction and unfavorable outcome was 0.96 (95% confidence interval [CI] 0.91, 0.99) and 0.92 (95% CI 0.85, 0.97) for T2/FLAIR injury. There was no difference in extent of diffusion restriction between patients who were alive with an unfavorable outcome and patients who died from WLST-neuro (p = 0.11). CONCLUSIONS More extensive diffusion restriction and T2/FLAIR injury on the modsASPECTS score within the first 14 days after pediatric cardiac arrest was associated with unfavorable outcomes at hospital discharge.
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Affiliation(s)
- Matthew P Kirschen
- From the Department of Anesthesiology and Critical Care Medicine (M.P.K., K.G., M.W., R.A.B., A.T.), Department of Pediatrics (M.P.K., D.J.L., R.A.B., A.T.), Health Analytics Unit (J.F., A.M.), and Department of Radiology (A.V.), Children's Hospital of Philadelphia; and Department of Neurology (M.P.K., D.J.L., R.B., R.D.-A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
| | - Daniel J Licht
- From the Department of Anesthesiology and Critical Care Medicine (M.P.K., K.G., M.W., R.A.B., A.T.), Department of Pediatrics (M.P.K., D.J.L., R.A.B., A.T.), Health Analytics Unit (J.F., A.M.), and Department of Radiology (A.V.), Children's Hospital of Philadelphia; and Department of Neurology (M.P.K., D.J.L., R.B., R.D.-A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jennifer Faerber
- From the Department of Anesthesiology and Critical Care Medicine (M.P.K., K.G., M.W., R.A.B., A.T.), Department of Pediatrics (M.P.K., D.J.L., R.A.B., A.T.), Health Analytics Unit (J.F., A.M.), and Department of Radiology (A.V.), Children's Hospital of Philadelphia; and Department of Neurology (M.P.K., D.J.L., R.B., R.D.-A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Antara Mondal
- From the Department of Anesthesiology and Critical Care Medicine (M.P.K., K.G., M.W., R.A.B., A.T.), Department of Pediatrics (M.P.K., D.J.L., R.A.B., A.T.), Health Analytics Unit (J.F., A.M.), and Department of Radiology (A.V.), Children's Hospital of Philadelphia; and Department of Neurology (M.P.K., D.J.L., R.B., R.D.-A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Kathryn Graham
- From the Department of Anesthesiology and Critical Care Medicine (M.P.K., K.G., M.W., R.A.B., A.T.), Department of Pediatrics (M.P.K., D.J.L., R.A.B., A.T.), Health Analytics Unit (J.F., A.M.), and Department of Radiology (A.V.), Children's Hospital of Philadelphia; and Department of Neurology (M.P.K., D.J.L., R.B., R.D.-A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Madeline Winters
- From the Department of Anesthesiology and Critical Care Medicine (M.P.K., K.G., M.W., R.A.B., A.T.), Department of Pediatrics (M.P.K., D.J.L., R.A.B., A.T.), Health Analytics Unit (J.F., A.M.), and Department of Radiology (A.V.), Children's Hospital of Philadelphia; and Department of Neurology (M.P.K., D.J.L., R.B., R.D.-A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Ramani Balu
- From the Department of Anesthesiology and Critical Care Medicine (M.P.K., K.G., M.W., R.A.B., A.T.), Department of Pediatrics (M.P.K., D.J.L., R.A.B., A.T.), Health Analytics Unit (J.F., A.M.), and Department of Radiology (A.V.), Children's Hospital of Philadelphia; and Department of Neurology (M.P.K., D.J.L., R.B., R.D.-A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Ramon Diaz-Arrastia
- From the Department of Anesthesiology and Critical Care Medicine (M.P.K., K.G., M.W., R.A.B., A.T.), Department of Pediatrics (M.P.K., D.J.L., R.A.B., A.T.), Health Analytics Unit (J.F., A.M.), and Department of Radiology (A.V.), Children's Hospital of Philadelphia; and Department of Neurology (M.P.K., D.J.L., R.B., R.D.-A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Robert A Berg
- From the Department of Anesthesiology and Critical Care Medicine (M.P.K., K.G., M.W., R.A.B., A.T.), Department of Pediatrics (M.P.K., D.J.L., R.A.B., A.T.), Health Analytics Unit (J.F., A.M.), and Department of Radiology (A.V.), Children's Hospital of Philadelphia; and Department of Neurology (M.P.K., D.J.L., R.B., R.D.-A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alexis Topjian
- From the Department of Anesthesiology and Critical Care Medicine (M.P.K., K.G., M.W., R.A.B., A.T.), Department of Pediatrics (M.P.K., D.J.L., R.A.B., A.T.), Health Analytics Unit (J.F., A.M.), and Department of Radiology (A.V.), Children's Hospital of Philadelphia; and Department of Neurology (M.P.K., D.J.L., R.B., R.D.-A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Arastoo Vossough
- From the Department of Anesthesiology and Critical Care Medicine (M.P.K., K.G., M.W., R.A.B., A.T.), Department of Pediatrics (M.P.K., D.J.L., R.A.B., A.T.), Health Analytics Unit (J.F., A.M.), and Department of Radiology (A.V.), Children's Hospital of Philadelphia; and Department of Neurology (M.P.K., D.J.L., R.B., R.D.-A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Slavova N, Fullerton HJ, Hills NK, Breiding PS, Mackay MT, Steinlin M. Validation of the focal cerebral arteriopathy severity score (FCASS) in a Swiss cohort: Correlation with infarct volume and outcome. Eur J Paediatr Neurol 2020; 28:58-63. [PMID: 32826156 DOI: 10.1016/j.ejpn.2020.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/09/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Focal cerebral arteriopathy (FCA), a major cause of childhood arterial ischemic stroke (AIS), can progress and lead to increased infarct size and/or recurrent stroke. Evaluating treatment options depends on the ability to quantify reliably the degree of stenosis in FCA. AIMS We validated the recently introduced FCA severity score (FCASS) in an independent cohort from the Swiss Neuro-Paediatric Stroke Registry (SNPSR). MATERIALS AND METHODS We included children with FCA who had MR or CT angiography and a Pediatric Stroke Outcome Measure (PSOM) at 6-months and 2-years post-stroke. A paediatric neuroradiologist applied the FCASS and the modified pediatric Alberta Stroke Program Early Computed Tomography Score (ASPECTS), a measure of infarct volume, to all available imaging. Two senior paediatric stroke neurologists and a neuroradiology fellow independently assigned FCASS scores to test interrater reliability. Pairwise correlations between FCASS, pedASPECTS, and PSOM were examined. RESULTS Thirty-two children [median (IQR) age = 5.9 (1.8, 9.6), 19 males] were included. The median maximum FCASS score at any time was 9 (IQR 6, 12; range 3, 16). Larger infarct volume scores correlated with both higher maximum FCASS scores and worse post-stroke outcomes, although we found no direct correlation between FCASS and outcomes. Stroke neurologists tended to assign lower FCASS scores than the neuroradiologist, but interrater reliability was predominantly good. CONCLUSIONS In this independent validation cohort, higher maximum FCASS correlated with greater infarct volume scores that also correlated with worse neurological outcomes. Scoring by non-imaging specialists seems to be valuable, although differences are present.
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Affiliation(s)
- Nedelina Slavova
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, and University of Bern, Switzerland; Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University Hospital, and University of Bern, Switzerland.
| | | | - Nancy K Hills
- Department of Neurology, University of California, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Philipe S Breiding
- Department of Diagnostic and Interventional Radiology, Kantonsspital Frauenfeld, Switzerland
| | - Mark T Mackay
- Royal Children's Hospital and Murdoch Children's Research Institute, University of Melbourne, Australia
| | - Maja Steinlin
- Division of Neuropaediatrics, University Hospital Inselspital, and University of Bern, Switzerland
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Gulati D, Golomb MR. Adding an imaging score in the armamentarium. Neurology 2020; 94:511-512. [DOI: 10.1212/wnl.0000000000009130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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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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26
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4927] [Impact Index Per Article: 1231.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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27
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Arterial ischemic stroke in non-neonate children: Diagnostic and therapeutic specificities. Rev Neurol (Paris) 2020; 176:20-29. [DOI: 10.1016/j.neurol.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5401] [Impact Index Per Article: 1080.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Perinatal strokes are a diverse but specific group of focal cerebrovascular injuries that occur early in brain development and affect an estimated 5 million people worldwide. The objective of this review is to describe the epidemiology, clinical presentations, pathophysiology, outcomes, and management for the 6 subtypes of perinatal stroke. Some perinatal strokes are symptomatic in the first days of life, typically with seizures, including neonatal arterial ischemic stroke, neonatal hemorrhagic stroke, and cerebral sinovenous thrombosis. The remaining subtypes present in the first year of life or later, usually with motor asymmetry and include arterial presumed perinatal ischemic stroke, presumed perinatal hemorrhagic stroke, and in utero periventricular venous infarction. The consequences of these injuries include cerebral palsy, epilepsy, and cognitive and behavioral challenges, in addition to the psychosocial impact on families. While there have been significant advances in understanding mechanisms of both injury and recovery, there is still a great deal to learn regarding causation and the optimization of outcomes.
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Affiliation(s)
- Mary Dunbar
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada; Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada; Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada.
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Mineyko A, Kirton A. Long-Term Outcome After Bilateral Perinatal Arterial Ischemic Stroke. Pediatr Neurol 2019; 101:39-42. [PMID: 31495662 DOI: 10.1016/j.pediatrneurol.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022]
Abstract
AIM We aimed to characterize the phenotype and outcome of children with bilateral, large vessel perinatal arterial ischemic stroke. METHODS Patients with bilateral, large vessel perinatal arterial ischemic stroke were identified from a large, population-based cohort (Alberta Perinatal Stroke Project). Subjects were included if stroke involving a major cerebral artery territory was documented in both cerebral hemispheres on magnetic resonance imaging. Standardized variables were extracted from charts including clinical presentations, associated potential risk factors, and outcomes. Outcome measures included the Pediatric Stroke Outcome Measure, Gross Motor Function Classification System, and epilepsy frequency score. Electroencephalographies were reviewed for sleep, epileptiform activity, and background. RESULTS Of 174 children with perinatal arterial ischemic stroke, eight (5%) had bilateral large artery infarcts. Patients were followed for a mean of 9.7 years (range 1.8 to 14.6 years). One child died. All children had a total Pediatric Stroke Outcome Measure of ≥2 (median 8, range 2 to 10) and Gross Motor Function Classification System ≥ II. Seven of eight (88%) children had a history of epilepsy. CONCLUSIONS Children with bilateral, large vessel perinatal stroke are at high risk of severe cognitive and motor sequelae. Epilepsy may also be more common than unilateral strokes. Cautious discussions with families regarding prognosis are recommended.
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Affiliation(s)
- Aleksandra Mineyko
- Section of Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Neurology, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
| | - Adam Kirton
- Section of Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Neurology, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Lockrow JP, Wright JN, Saneto RP, Amlie-Lefond C. Epileptic Spasms Predict Poor Epilepsy Outcomes After Perinatal Stroke. J Child Neurol 2019; 34:830-836. [PMID: 31339419 DOI: 10.1177/0883073819863278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Perinatal stroke is a significant cause of severe epilepsy, including epileptic spasms. Although epileptic spasms due to underlying structural lesion often respond poorly to treatment and evolve into drug-resistant epilepsy, outcomes are not uniformly poor, and predictors of outcomes are not well described. We performed a single-institution retrospective review of epileptic spasms following perinatal stroke to determine if outcome depended on vascular subtype. We identified 24 children with epileptic spasms due to perinatal ischemic stroke: 11 cases of perinatal arterial stroke and 13 cases of perinatal venous infarct. Initial response to treatment was similar between groups; however, although children with perinatal arterial stroke who responded to epileptic spasms therapy had high rates of seizure freedom, many children with perinatal venous infarct, regardless of initial response, had residual drug-resistant epilepsy. We consider whether the mechanism for epileptogenesis may be different between arterial and venous strokes, and whether these 2 groups should be monitored for epileptic spasms, and subsequent epilepsy, differently.
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Affiliation(s)
- Jason P Lockrow
- Department of Neurology, Section of Pediatric Neurology, University of Washington, Seattle, WA, USA
| | - Jason N Wright
- Department of Neurology, Section of Neuroradiology, University of Washington, Seattle, WA, USA
| | - Russell P Saneto
- Department of Neurology, Section of Pediatric Neurology, University of Washington, Seattle, WA, USA
| | - Catherine Amlie-Lefond
- Department of Neurology, Section of Pediatric Neurology, University of Washington, Seattle, WA, USA
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Marchi A, Pennaroli D, Lagarde S, McGonigal A, Bonini F, Carron R, Lépine A, Villeneuve N, Trebuchon A, Pizzo F, Scavarda D, Bartolomei F. Epileptogenicity and surgical outcome in post stroke drug resistant epilepsy in children and adults. Epilepsy Res 2019; 155:106155. [DOI: 10.1016/j.eplepsyres.2019.106155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/04/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
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Fluss J, Dinomais M, Chabrier S. Perinatal stroke syndromes: Similarities and diversities in aetiology, outcome and management. Eur J Paediatr Neurol 2019; 23:368-383. [PMID: 30879961 DOI: 10.1016/j.ejpn.2019.02.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/04/2019] [Accepted: 02/24/2019] [Indexed: 01/09/2023]
Abstract
With a birth-prevalence of 37-67/100,000 (mostly term-born), perinatal stroke encompasses distinct disease-states with diverse causality, mechanism, time of onset, mode of presentation and outcome. Neonatal primary haemorrhagic stroke and ischemic events (also divided into neonatal arterial ischemic stroke and neonatal cerebral sinus venous thrombosis) that manifest soon after birth are distinguished from presumed perinatal - ischemic or haemorrhagic - stroke. Signs of the latter become apparent only beyond the neonatal period, most often with motor asymmetry or milestones delay, and occasionally with seizures. Acute or remote MRI defines the type of stroke and is useful for prognosis. Acute care relies on homeostatic maintenance. Seizures are often self-limited and anticonvulsant agents might be discontinued before discharge. Prolonged anticoagulation for a few weeks is an option in some cases of sinovenous thrombosis. Although the risk of severe impairment is low, many children develop mild to moderate multimodal developmental issues that require a multidisciplinary approach.
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Affiliation(s)
- Joel Fluss
- Pediatric Neurology Unit, Geneva Children's Hospital, 6 rue Willy-Donzé, 1211 Genève 4, Switzerland
| | - Mickaël Dinomais
- CHU Angers, Département de Médecine Physique et de Réadaptation, CHU Angers-Capucins, F-49933, Angers, France; Université d'Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) EA7315, F-49000, Angers, France
| | - Stéphane Chabrier
- CHU Saint-Étienne, French Centre for Paediatric Stroke, Paediatric Physical and Rehabilitation Medicine Department, INSERM, CIC 1408, F-42055, Saint-Étienne, France; INSERM, U1059 Sainbiose, Univ Saint-Étienne, Univ Lyon, F-42023, Saint-Étienne, France.
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Clive B, Vincer M, Ahmad T, Khan N, Afifi J, El-Naggar W. Epidemiology of neonatal stroke: A population-based study. Paediatr Child Health 2019; 25:20-25. [PMID: 33390736 DOI: 10.1093/pch/pxy194] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022] Open
Abstract
Objective The goal of this study was to obtain population-based data on the incidence, clinical presentation, management, imaging features, and long-term outcomes of patients with all types of neonatal stroke (NS). Methods Full-term neonates with NS born between January 2007 and December 2013 were identified through the Nova Scotia Provincial Perinatal Follow-up Program Database. Perinatal data and neonatal course were reviewed. Neurodevelopmental outcomes were assessed at 18 and 36 months of age using standardized testing. Results Twenty-nine neonates with NS were identified during the study period, giving an incidence of 47 per 100,000 live births in Nova Scotia. Arterial ischemic stroke was the most common stroke type (76%), followed by neonatal hemorrhagic stroke (17%), then cerebral sinovenous thrombosis (7%). The majority of neonates presented with seizures (86%) on the first day of life (76%). At 36 months of age, 23 (79%) of the children had a normal outcome, while 3 (10%) were diagnosed with cerebral palsy (2 with neonatal arterial stroke and one with neonatal hemorrhagic stroke) and 3 (10%) had recurrent seizures (1 patient from each stroke subtype group). Conclusion The incidence of NS in Nova Scotia is higher than what has been reported internationally in the literature. However, the neurodevelopmental outcomes at 3 years of age are better. Further studies are required to better understand the reasons for these findings.
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Affiliation(s)
- Breanna Clive
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
| | - Michael Vincer
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
| | - Tahani Ahmad
- Departemnt of Diagnostic Imaging, Dalhousie University, Halifax, Nova Scotia
| | - Naeem Khan
- Departemnt of Diagnostic Imaging, Dalhousie University, Halifax, Nova Scotia
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
| | - Walid El-Naggar
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
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Lehman LL, Beslow LA, Steinlin M, Kossorotoff M, Mackay MT. What Will Improve Pediatric Acute Stroke Care? Stroke 2019; 50:249-256. [DOI: 10.1161/strokeaha.118.022881] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Laura L. Lehman
- From the Department of Neurology, Boston Children’s Hospital, Harvard Medical School, MA (L.L.L.)
| | - Lauren A. Beslow
- Division of Neurology, Departments of Neurology and Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.A.B.)
| | - Maja Steinlin
- Division of Paediatric Neurology, University Children’s Hospital Bern, University of Bern, Switzerland (M.S.)
| | - Manoëlle Kossorotoff
- French Center for Pediatric Stroke, Pediatric Neurology, APHP University Hospital Necker-Enfants Malades, Paris, France (M.K.)
| | - Mark T. Mackay
- Department of Neurology, Royal Children’s Hospital, Murdoch Children’s Research Institute, University of Melbourne, Parkville, Australia (M.T.M.)
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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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Rattani A, Lim J, Mistry AM, Prablek MA, Roth SG, Jordan LC, Shannon CN, Naftel RP. Incidence of Epilepsy and Associated Risk Factors in Perinatal Ischemic Stroke Survivors. Pediatr Neurol 2019; 90:44-55. [PMID: 30409458 DOI: 10.1016/j.pediatrneurol.2018.08.025] [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: 05/07/2018] [Revised: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Epilepsy is a serious and often lifelong consequence of perinatal arterial ischemic stroke (PAIS). Variable incidences and risk factors for long-term epilepsy in PAIS have been reported. To determine the incidence of epilepsy in PAIS survivors and report factors associated with the risk of developing epilepsy, a meta-analysis and systematic review of prior publications was performed. METHODS We examined studies on perinatal or neonatal patients (≤28 days of life) with arterial ischemic strokes in which the development of epilepsy was reported. EMBASE and MEDLINE/PubMed databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS A meta-analysis of 10 studies revealed a summary incidence of epilepsy in PAIS patients of 27.2% (95% confidence interval 16.6% to 41.4%) over a mean study duration of 10.4 years (range 1.5 to 17). More recent studies generally reported a lower epilepsy incidence. A systematic review identified seven possible risk factors for epilepsy in PAIS patients: hippocampal volume reduction, infarct on prenatal ultrasound, a modified Alberta Stroke Program Early Computed Tomography score ≥9, family history of seizures, cerebral palsy, and initial presentation with cognitive impairment or seizures. CONCLUSIONS About a third of children with PAIS will develop epilepsy. While seven possible risk factors have been reported, further research is warranted to confirm the strength of their association with the development of epilepsy.
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Affiliation(s)
- Abbas Rattani
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois; Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Jaims Lim
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Neurosurgery, University at Buffalo, Buffalo, New York
| | - Akshitkumar M Mistry
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marc A Prablek
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Steven G Roth
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chevis N Shannon
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert P Naftel
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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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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Clinical Characteristics, Diagnosis and Management of Neonatal Stroke. IRANIAN JOURNAL OF PEDIATRICS 2018. [DOI: 10.5812/ijp.64332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Fox CK, Jordan LC, Beslow LA, Armstrong J, Mackay MT, deVeber G. Children with post-stroke epilepsy have poorer outcomes one year after stroke. Int J Stroke 2018; 13:820-823. [PMID: 29956597 DOI: 10.1177/1747493018784434] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Epilepsy is a common complication of pediatric stroke. Aim In this study, we aim to measure the association between epilepsy and neurologic outcome after childhood arterial ischemic stroke. Methods Prospective cohort study of children (29 days-19 years) enrolled after an acute arterial ischemic stroke at 21 international pediatric stroke centers and followed to identify epilepsy. One year post-stroke, outcomes were scored using the examination-based Pediatric Stroke Outcome Measure (range = 0-10); higher values reflect greater disability. Ordinal logistic regression was used to measure the association of Pediatric Stroke Outcome Measure scores (categorized as 0-1, 1.5-3, 3.5-6, 6.5-10) with epilepsy. Results Investigators enrolled 86 children (median age = 6.1 years, interquartile range (IQR) = 1.4-12.2 years) with acute stroke. At 1 year, 18/80 (23%) remained on an anticonvulsant including 8/80 (10%) with epilepsy. Among the 70 with Pediatric Stroke Outcome Measure scored, the median was 0.5 (IQR = 0-1.5) for children without epilepsy ( n = 63), and 6 (IQR = 0.5-10) for children with epilepsy ( n = 7). In univariable analyses, poorer 1-year outcome was associated with middle cerebral artery stroke, cortical infarcts, hemorrhagic transformation, hospital disposition not to home, and epilepsy. In multivariable analysis, middle cerebral artery stroke (odds ratio (OR) = 4.9, 95% confidence intervals (CI) = 1.1-21.3) and epilepsy (OR = 24.1, CI = 1.5-380) remained associated with poorer outcome. Conclusions Children who developed epilepsy during the first year post-stroke had poorer neurologic outcomes than those without epilepsy.
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Affiliation(s)
- Christine K Fox
- 1 Neurology and Pediatrics Departments, University of California, San Francisco, San Francisco, CA, USA
| | - Lori C Jordan
- 2 Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren A Beslow
- 3 Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Mark T Mackay
- 5 Department of Neurology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Gabrielle deVeber
- 6 Neurology Division, Department of Pediatrics, Hospital for Sick Children, University of Toronto, ON, Canada
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Neuropsychological Outcome in Perinatal Stroke Associated With Epileptiform Discharges in Sleep. Can J Neurol Sci 2018; 44:358-365. [PMID: 28767035 DOI: 10.1017/cjn.2017.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with arterial perinatal stroke often suffer long-term motor sequelae, difficulties in language, social development, and behaviour as well as epilepsy. Despite homogeneous lesions, long-term behavioural and cognitive outcomes are variable and unpredictable. Sleep-related epileptic encephalopathies can occur after early brain injury and are associated with global developmental delays. We hypothesized that sleep-potentiated epileptiform abnormalities are associated with worse developmental outcomes after perinatal stroke. METHODS Participants were identified from a population-based cohort (Alberta Perinatal Stroke Project). Inclusion criteria were magnetic resonance imaging-confirmed arterial perinatal stroke, age 4 to 18 years, electroencephalogram (EEG) including sleep, and comprehensive neuropsychological evaluation. Sleep-related EEG abnormalities were categorized by an epileptologist blinded to the cognitive outcome. Associations between EEG classification and neuropsychological outcomes were explored (t tests, Bonferroni correction for multiple comparisons). RESULTS Of 128 potentially eligible participants, 34 (53% female) had complete EEG (mean age, 8.1 years; range, 0.2-16.4) and neuropsychology testing (mean age, 9.8 years; range 4.4-16.7). Twelve (35%) were classified as having electrical status epilepticus in sleep. Patients with abnormal EEGs were more likely to have statistically worse scores when corrected for multiple comparisons, in receptive language (median, 1st percentile; IQR 1-7th percentile; p<0.05), and externalizing behaviours (median, 82nd percentile; IQR, 79-97th percentile; p<0.05). CONCLUSIONS Developmental outcome in language and behaviour in children with arterial perinatal stroke is associated with electrical status epilepticus in sleep. Increased screening with sleep EEG is suggested, whereas further studies are necessary to determine if treatment of EEG abnormalities can improve outcome.
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4550] [Impact Index Per Article: 758.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Laugesaar R, Vaher U, Lõo S, Kolk A, Männamaa M, Talvik I, Õiglane-Shlik E, Loorits D, Talvik T, Ilves P. Epilepsy after perinatal stroke with different vascular subtypes. Epilepsia Open 2018; 3:193-202. [PMID: 29881798 PMCID: PMC5983200 DOI: 10.1002/epi4.12104] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2018] [Indexed: 02/04/2023] Open
Abstract
Objective With an incidence up to 63 per 100,000 live births, perinatal stroke is an important cause of childhood epilepsy. The aim of the study was to find the prevalence of and predictive factors for epilepsy, and to describe the course of epilepsy in children with perinatal stroke with different vascular subtypes. Methods Patients were retrieved from the Estonian Paediatric Stroke Database with follow‐up time at least 24 months. Patients were divided into 5 perinatal stroke syndromes: neonatal arterial ischemic stroke (AIS), neonatal hemorrhagic stroke, neonatal cerebral sinovenous thrombosis, presumed AIS, and presumed periventricular venous infarction. Results The final study group included 73 children with perinatal stroke (39 boys). With a median follow‐up time of 8.6 years, epilepsy was diagnosed in 21/73 (29%) children, most of whom had AIS (17/21, 81%). The 18‐year cumulative poststroke epilepsy risk according to the Kaplan‐Meier estimator was 40.8% (95% confidence interval [CI] 20.7–55.9%). The median age at epilepsy diagnosis was 50 months (range 1 month to 18.4 years). Children with neonatal AIS had the highest risk of epilepsy, but children with presumed AIS more often had severe epilepsy syndromes. Cortical lesions (odds ratio [OR] 19.7, 95% CI 2.9–133), and involvement of thalamus (OR 9.8, 95% CI 1.8–53.5) and temporal lobe (OR 8.3, 95% CI 1.8–39.6) were independently associated with poststroke epilepsy. Significance The risk for poststroke epilepsy after perinatal stroke depends on the vascular subtype. Patients with perinatal AIS need close follow‐up to detect epilepsy and start with antiepileptic treatment on time.
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Affiliation(s)
- Rael Laugesaar
- Department of Pediatrics Institute of Clinical Medicine University of Tartu Tartu Estonia.,Children's Clinic of Tartu University Hospital Tartu Estonia
| | - Ulvi Vaher
- Children's Clinic of Tartu University Hospital Tartu Estonia
| | - Silva Lõo
- Department of Pediatrics Institute of Clinical Medicine University of Tartu Tartu Estonia.,Children's Hospital Pediatric Research Centre University of Helsinki Helsinki Finland.,Helsinki University Hospital Helsinki Finland
| | - Anneli Kolk
- Department of Pediatrics Institute of Clinical Medicine University of Tartu Tartu Estonia.,Children's Clinic of Tartu University Hospital Tartu Estonia
| | - Mairi Männamaa
- Department of Pediatrics Institute of Clinical Medicine University of Tartu Tartu Estonia.,Children's Clinic of Tartu University Hospital Tartu Estonia.,Institute of Psychology University of Tallinn Tallinn Estonia
| | - Inga Talvik
- Department of Neurology and Rehabilitation Tallinn Children's Hospital Tallinn Estonia
| | - Eve Õiglane-Shlik
- Department of Pediatrics Institute of Clinical Medicine University of Tartu Tartu Estonia.,Children's Clinic of Tartu University Hospital Tartu Estonia
| | - Dagmar Loorits
- Radiology Clinic of Tartu University Hospital Tartu Estonia
| | - Tiina Talvik
- Department of Pediatrics Institute of Clinical Medicine University of Tartu Tartu Estonia.,Children's Clinic of Tartu University Hospital Tartu Estonia
| | - Pilvi Ilves
- Radiology Clinic of Tartu University Hospital Tartu Estonia.,Department of Radiology Institute of Clinical Medicine University of Tartu Tartu Estonia
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Natarajan N, Beatty CW, Gust J, Hamiwka L. Provider Practices of Phenobarbital Discontinuation in Neonatal Seizures. J Child Neurol 2018; 33:153-157. [PMID: 29256315 DOI: 10.1177/0883073817745990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neonatal seizures are treated with phenobarbital and prolonged treatment does not prevent postneonatal epilepsy. The authors documented factors influencing phenobarbital use and determined whether published data changed practice. A total of 83 neonates with symptomatic seizures, clinical or electrographic, were evaluated for treatment, incidence of postneonatal epilepsy, and associated factors. Median phenobarbital treatment was 81 days. Nineteen children (23%) developed postneonatal epilepsy. Longer duration of seizures and an infectious etiology were associated with postneonatal epilepsy suggesting no impact on duration of phenobarbital treatment. Treatment duration was associated with duration of seizures and use of a second antiseizure medication. This study supports early discontinuation of phenobarbital and suggests providers utilize factors such as use of a second antiseizure medication and time to seizure control to determine phenobarbital duration, despite prior studies suggesting no impact of treatment length.
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Affiliation(s)
- Niranjana Natarajan
- 1 Department of Neurology, Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Christopher W Beatty
- 1 Department of Neurology, Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Juliane Gust
- 1 Department of Neurology, Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Lorie Hamiwka
- 1 Department of Neurology, Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
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Husson B, Durand C, Hertz-Pannier L. [Recommendations for imaging neonatal ischemic stroke]. Arch Pediatr 2017; 24:9S19-9S27. [PMID: 28867033 DOI: 10.1016/s0929-693x(17)30327-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Neuroimaging is critical for the diagnosis of neonatal arterial ischemic stroke (NAIS) and for prognosis estimation. The purpose of this work is to define guidelines of clinical neuroimaging for the diagnosis of NAIS, for the optimization of the imaging timing and for the assessment of the prognostic value of each imaging technique. A systematic search of electronic databases (Medline via Pubmed) for studies whose title and abstract were focused on NAIS has been conducted. One hundred and ten articles were selected and their results were analyzed by three Senior Practitioners of pediatric radiology using common methodology for guidelines elaboration within the group of experts gathered by Scientific Societies in the field. MRI with a diffu si on-weighted sequence (DWI) and T1, T2, and T2*-weighted sequences must be performed in the case of suspected NAIS (no sedation is required). In the first hours after the injury, an acute ischemic lesion is characterized by a hypersignal on the diffusion-weighted sequence, with a decrease of the apparent coefficient of diffusion (ADC). The best time to evaluate the extent of the ischemic lesion is between day 2 and day 4 after injury, when the ADC decrease reaches its nadir. In the acute phase, US may be useful as first imaging at the bedside to exclude other pathologies like large space-occupying hemorrhages, but its specific added value on NAIS diagnosis or prognosis assessment is very low. CT scan has no added value in NAIS, compared to MRI. Motor outcome is correlated with the extent of the lesion and with the presence of a definite injury of the corticospinal tract, which is well seen on the diffusion sequence at the acute stage. A secondary atrophy within the mesencephalon (cerebral peduncles) is tied in with a high risk of hemiplegia. Visual outcome is more often compromised in the case of lesions of the posterior cerebral artery territory.
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Affiliation(s)
- B Husson
- AP-HP, centre national de référence de l'AVC de l'enfant et service de radiologie pédiatrique, Hôpital Le Kremlin-Bicêtre, 78, rue du Général-Leclerc, Le Kremlin-Bicêtre, 94270 France.
| | - C Durand
- CHU de Grenoble, clinique d'imagerie pédiatrique, hôpital Couple-Enfant, quai Yermoloff, Grenoble, 38043 France
| | - L Hertz-Pannier
- UMR129, INSERM/Université Paris-Descartes, UNIACTZ/Neurospin, CEA-Saclay Bat 145, Gif-sur-Yvette, 9191 France
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Bosenbark DD, Krivitzky L, Ichord R, Vossough A, Bhatia A, Jastrzab LE, Billinghurst L. Clinical Predictors of Attention and Executive Functioning Outcomes in Children After Perinatal Arterial Ischemic Stroke. Pediatr Neurol 2017; 69:79-86. [PMID: 28274640 DOI: 10.1016/j.pediatrneurol.2017.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/12/2017] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Children with perinatal arterial ischemic stroke (PAIS) are at risk for later neurocognitive and behavioral deficits, yet the clinical predictors of these outcomes are understudied. We examined the influence of clinical and infarct characteristics on attention and executive functioning in children following PAIS. METHODS Forty children born at term (≥37 weeks' gestation) with PAIS (28 with neonatal arterial ischemic stroke and 12 with presumed PAIS) underwent a comprehensive neuropsychological battery at age three to 16 years (median age 7.2 years; 58% male) to assess attention and executive functioning. Parents also completed questionnaires regarding real-world functioning. Clinical variables including perinatal stroke subtype, infarct characteristics (location, laterality, and volume), and the presence of comorbid epilepsy were ascertained from the medical record. RESULTS Presumed PAIS, larger infarct volume, and comorbid epilepsy negatively influenced the performance on attention and executive functioning measures. These clinical variables were also associated with greater functional problems on parent reports, including a higher frequency of attention-deficit/hyperactivity disorder symptoms and greater difficulties in some subdomains of executive functioning. Infarct location and laterality were not associated with performance measures or parental report of functioning. CONCLUSION Although all children with PAIS are at risk for later deficits in attention and executive functioning, those with presumed PAIS, larger infarct size, and comorbid epilepsy appear to be the most vulnerable. As they approach and reach school age, these children should undergo neuropsychological assessment to ensure timely implementation of therapeutic interventions and behavioral strategies.
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Affiliation(s)
- Danielle D Bosenbark
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lauren Krivitzky
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rebecca Ichord
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Arastoo Vossough
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aashim Bhatia
- Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Laura E Jastrzab
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lori Billinghurst
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
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47
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6120] [Impact Index Per Article: 874.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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48
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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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49
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Shellhaas RA, Chang T, Wusthoff CJ, Soul JS, Massey SL, Chu CJ, Cilio MR, Bonifacio SL, Abend NS, Tsuchida TN, Glass HC. Treatment Duration After Acute Symptomatic Seizures in Neonates: A Multicenter Cohort Study. J Pediatr 2017; 181:298-301.e1. [PMID: 27829512 PMCID: PMC5322461 DOI: 10.1016/j.jpeds.2016.10.039] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/15/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
We aimed to define determinants of duration of treatment for acute symptomatic neonatal seizures in a contemporary multicenter observational cohort study. After adjustment for potential confounders, only study site and seizure etiology remained significantly associated with the chance of continuing antiseizure medication after discharge to home.
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Affiliation(s)
- Renée A. Shellhaas
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Taeun Chang
- Department of Neurology, Children’s National Health System, George Washington University School of Medicine, Washington, DC
| | | | - Janet S. Soul
- Department of Neurology, Boston Children’s Hospital, Boston, MA
| | - Shavonne L. Massey
- Departments of Neurology and Pediatrics, The Perelman School of Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Catherine J. Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - M. Roberta Cilio
- Departments of Neurology and Pediatrics, University of California San Francisco Benioff Children’s Hospital, University of California San Francisco, San Francisco, CA
| | - Sonia L. Bonifacio
- Departments of Neurology and Pediatrics, Stanford University, Palo Alto, CA
| | - Nicholas S. Abend
- Departments of Neurology and Pediatrics, The Perelman School of Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Tammy N. Tsuchida
- Department of Neurology, Children’s National Health System, George Washington University School of Medicine, Washington, DC
| | - Hannah C. Glass
- Departments of Neurology and Pediatrics, University of California San Francisco Benioff Children’s Hospital, University of California San Francisco, San Francisco, CA,Department of Epidemiology and Biostatistics; University of California San Francisco, San Francisco, CA
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50
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Billinghurst LL, Beslow LA, Abend NS, Uohara M, Jastrzab L, Licht DJ, Ichord RN. Incidence and predictors of epilepsy after pediatric arterial ischemic stroke. Neurology 2017; 88:630-637. [PMID: 28087825 DOI: 10.1212/wnl.0000000000003603] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 11/23/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the cumulative incidence and clinical predictors of remote symptomatic seizures and epilepsy after pediatric arterial ischemic stroke (AIS). METHODS We performed a retrospective analysis of 218 participants with neonatal AIS (NAIS), presumed perinatal AIS (PPAIS), and childhood AIS (CAIS) from a single-center prospective consecutive cohort enrolled from 2006 to 2014. Medical records were reviewed for timing, semiology, and treatment of acute symptomatic seizures, remote symptomatic seizures (RSS), and epilepsy. Cumulative incidence of RSS and epilepsy were assessed using survival analysis. RESULTS Acute symptomatic seizures occurred in 94% of NAIS (n = 70/74) and 17% of CAIS (n = 18/105). Younger children were more likely to present with seizures at stroke ictus, and acute symptomatic seizures were predictive of later RSS and epilepsy in CAIS. Median follow-up for the entire cohort was 34 months, interquartile range 44.9 months (16.3-61.2). Estimated cumulative incidence of RSS at 2 years was 19% in NAIS, 24% in PPAIS, and 7% in CAIS. Estimated cumulative incidence of epilepsy at 2 years was 11% in NAIS, 19% in PPAIS, and 7% in CAIS. The median time to these outcomes was <2 years in all stroke subtypes. Among participants developing epilepsy (n = 34), seizures were often well-controlled at last follow-up with median Engel class of ≤2 (<1 seizure/month). CONCLUSIONS RSS and epilepsy are important neurologic sequelae of pediatric AIS. Children with perinatal stroke and CAIS with acute symptomatic seizures are at increased risk of these outcomes. These cohorts need further study to identify biomarkers and potential therapeutic targets for epileptogenesis.
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Affiliation(s)
- Lori L Billinghurst
- From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA.
| | - Lauren A Beslow
- From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA
| | - Nicholas S Abend
- From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA
| | - Michael Uohara
- From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA
| | - Laura Jastrzab
- From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA
| | - Daniel J Licht
- From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA
| | - Rebecca N Ichord
- From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA
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