Predictors of outcome in perinatal arterial stroke: A population‐based study

Abstract

Some infants with perinatal arterial ischemic stroke (PAS) experience development of cerebral palsy (CP), epilepsy, and cognitive impairment, whereas others have a normal outcome. Previous prognostic studies rarely have included all diagnosed cases of PAS within a population. Among 199,176 infants born within Kaiser Permanente from 1997 to 2002, we electronically identified head imaging reports and physician diagnoses suggesting stroke. The diagnosis of PAS was confirmed by review of brain imaging and medical records. Presentation of PAS was considered delayed if symptoms were only noted after 28 days. Outcomes were determined by chart review. Of 40 infants with PAS, 36 were observed over 12 months. Abnormal outcomes included CP (58%), epilepsy (39%), language delay (25%), and behavioral abnormalities (22%). A delayed presentation was associated with increased risk for CP (relative risk [RR], 2.2; 95% confidence interval [CI], 1.2-4.2). Radiological predictors of CP included large stroke size (RR, 2.0; 95% CI, 1.2-3.2) and injury to Broca's area (RR, 2.5; 95% CI, 1.3-5.0), internal capsule (RR, 2.2; 95% CI, 1.1-4.4), Wernicke's area (RR, 2.0; 95% CI, 1.1-3.8), or basal ganglia (RR, 1.9; 95% CI, 1.1-3.3). Among infants with PAS, specific radiological findings and a lack of symptoms in the newborn period are associated with increased risk for CP.

Vascular Dysfunction in Women with Recurrent Pregnancy Loss

“…Perinatal arterial ischemic stroke (PAS), defined as a thromboembolic event occurring before age 28 days, is an increasingly recognized cause of neurological disabilities such as cerebral palsy, epilepsy, and cognitive abnormalities (Lee et al, 2005). PAS occurs at a frequency of 1/1600 to 1/5000 live births (Chabriera et al, 2010).…”

Therapeutic approaches and advances in pediatric stroke

“…39 In neonates, peripartum factors such as preeclampsia, prolonged rupture of membranes, and placental abnormalities are risks. 6,40 In older children, metabolic disorders may produce stroke or stroke-like episodes including MELAS, 41 Fabry disease, 42 and hyperhomocysteinemia. 11 Neurocutaneous syndromes associated with pediatric stroke include tuberous sclerosis, neurofibromatosis type 1, epidermal nevus syndromes, incontientia pigmenti, the and the PHACES syndrome.…”

“…6,64 In symptomatic perinatal stroke, mortality rates are 10-fold higher compared to older children 1 and neurological deficits or epilepsy occur in 50-66% of survivors. 3,40,65,66 Deficits include sensori-motor, language, visual, cognitive and behavioural problems. 3,40,65,66 .…”

“…3,40,65,66 Deficits include sensori-motor, language, visual, cognitive and behavioural problems. 3,40,65,66 . The outcome from stroke in infancy is often assumed to be better than that for older children, which is in turn better than adults, 6,65 a finding often attributed to increased "plasticity" though proof of this and an understanding of the mechanisms that might underlie it are lacking.…”

Magnetization transfer and diffusion imaging of acute axonal damage in the cerebral peduncle following hypoxia–ischemia in neonatal rats

“…Determination of MRI abnormalities such as lesion size and location shows consistent but relatively weak associations with long-term outcomes (3,10,11). By contrast, function-specific imaging biomarkers may have greater potential to predict outcomes.…”