Association of Acute Infarct Topography With Development of Cerebral Palsy and Neurologic Impairment in Neonates With Stroke

Abstract

ObjectivesResearch investigating neonatal arterial ischemic stroke (NAIS) outcomes have shown that combined cortical and basal ganglia infarction or involvement of the corticospinal tract predict cerebral palsy (CP). The research question was whether voxel-based lesion-symptom mapping (VLSM) on acute MRI can identify brain regions associated with CP and neurodevelopmental impairments in neonatal arterial ischemic stroke (NAIS).MethodsNewborns were recruited from prospective Australian and Swiss pediatric stroke registries. CP diagnosis was based on clinical examination. Language and cognitive-behavioral impairments were assessed using the Pediatric Stroke Outcome Measure, dichotomized to good (0-0.5) or poor (≥ 1), at ≥18 months of age. Infarcts were manually segmented using diffusion-weighted imaging, registered to a neonatal-specific brain template. VLSM was conducted using MATLAB SPM12 toolbox. A general linear model was used to correlate lesion masks with motor, language and cognitive-behavioral outcomes. Voxel-wise t-teststatistics were calculated, correcting for multiple comparisons using family-wise error rate (FWE).Results:Eighty-five newborns met inclusion criteria. Infarct lateralization was left hemisphere (62%), right (8%) and bilateral (30%). At median age 2.1 years (IQR 1.9-2.6), 33% developed CP and 42% had neurological impairments. 54 grey and white matter regions correlated with CP (t>4.33; FWE <0.05), including primary motor pathway regions, such as the precentral gyrus, and cerebral peduncle, and regions functionally connected to the primary motor pathway, such as the pallidum, and corpus callosum motor segment. No significant correlations were found for language or cognitive-behavioral outcomes.ConclusionsCP following NAIS correlates with infarct regions directly involved in motor control and, orin functionally connected regions. Areas associated with language or cognitive-behavioral impairment are less clear.

Structural networking of the developing brain: from maturation to neurosurgical implications

“…The type of reorganization of the CST depends on several factors including the type and timing of the injury, the size and location of lesion, and the plasticity potential of the CST itself ( Staudt et al, 2002 , 2004 ). At a microscopic level, the site of primary lesion is characterized by the higher degree of altered myelination with progressive normalization towards remote ipsilesional and contralesional regions ( Mackay et al, 2023 ).…”

“…The type of reorganization of the CST depends on several factors including the type and timing of the injury, the size and location of lesion, and the plasticity potential of the CST itself (Staudt et al, 2002(Staudt et al, , 2004. At a microscopic level, the site of primary lesion is characterized by the higher degree of altered myelination with progressive normalization towards remote ipsilesional and contralesional regions (Mackay et al, 2023). Therefore, the gravity of post-stroke motor and other neurological deficits often correlates with the lesion size, and especially during the early third trimester, with involvement of the medial periventricular WM, where cortico-spinal motor pathways run from the primary motor cortex to the internal capsule (Dinomais et al, 2015;Stiles et al, 2015).…”