The role of brain territorial involvement and infection/inflammation in the long-term outcome of neonates with arterial ischemic stroke: A population-based cohort study

Vojcek, Eszter; Jermendy, Ágnes; László, Anna; Gráf, Rózsa; Rudas, Gábor; Berenyi, Marianne; Seri, István

doi:10.1016/j.earlhumdev.2021.105393

Cited by 10 publications

(27 citation statements)

References 42 publications

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“…In agreement with previously published studies, one-third of the patients with perinatal stroke developed later cerebral palsy [34]. In our study, the finding that the rate of cerebral palsy was only 16% among neonates with perinatal stroke and CHD (Study Group) must be interpretated with caution.…”

Section: Discussionsupporting

confidence: 93%

“…However, in addition to investigating the perinatal risk factors in neonates with CHD and perinatal stroke, we followed a high proportion of infants for at least 18 months and with a median follow-up age of 61 months. The rate of adverse neurodevelopmental outcome in the Control-1 and Control-2 Groups was also similar to that described in previously published studies [24,33,34].…”

Section: Discussionsupporting

confidence: 89%

“…The authors instead suggested identifying brain lesions based on etiology instead of the imaging pattern to predict neurodevelopmental outcome [41]. On the other hand, in previous studies on larger patient population, we showed that in neonates with arterial ischemic stroke, the main MCA stroke, multiple strokes, the involvement of the corticospinal tract and the presence of infection/inflammation were independent predictors of adverse outcome [34], while in neonates with hemorrhagic stroke, the parietal lobe hemorrhage, the involvement of the thalamus/basal ganglia, hemorrhage affecting multiple lobes and seizures on admission were associated with adverse outcome [42].…”

Section: Discussionmentioning

confidence: 75%

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Mortality and Long-Term Outcome of Neonates with Congenital Heart Disease and Acute Perinatal Stroke: A Population-Based Case-Control Study

Vojcek¹,

Gyarmathy²,

Gráf³

et al. 2022

Congenital Heart Disease

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Objective: Neonates with congenital heart disease (CHD) and perinatal stroke have high mortality and survivors are at risk for poor long-term neurodevelopmental outcome. The aim of this study was to assess the risk factors and outcome of neonates with both CHD and MRI-confirmed perinatal stroke (Study Group) and compare those to the risk factors and outcome of infants matched for CHD without stroke (Control-1) and of infants matched for MRI-confirmed stroke without CHD (Control-2). Methods: We conducted a population-based case-control study enrolling 28 term neonates with CHD and MRI-confirmed acute perinatal stroke born between 2007-2017 in the Central-Hungarian Region. Each of the control groups included 56 infants. The Bayley Scales of Infant Development-II, the Brunet-Lézine test and the Binet Intelligence scales-V were used for neurodevelopmental follow-up at a median age of 61 months. Results: Mortality was highest in the Study Group (25% compared to 5% and 2%, respectively, p = 0.001). Adverse neurodevelopmental outcome was prevalent in the Study (53%) and Control-2 Groups (52%, p = 0.03). Significantly different parameters among the three groups included Apgar scores, mode of delivery, gestational age at birth, cardiac interventions and twin pregnancy. In a multivariable regression analysis adjusted for clinically relevant parameters, patients in the Study Group had significantly higher odds for mortality compared to patients in the Control-1 Group (OR: 6.5 95% CI: 1.1-39.4). Conclusions: Neonates with perinatal stroke and CHD are at a higher risk for dying compared to neonates with CHD without stroke. In addition, the stroke-associated direct insult to the brain likely plays an important role in the development of neurodevelopmental morbidity in these patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 75%

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Mortality and Long-Term Outcome of Neonates with Congenital Heart Disease and Acute Perinatal Stroke: A Population-Based Case-Control Study

Vojcek¹,

Gyarmathy²,

Gráf³

et al. 2022

Congenital Heart Disease

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“…Findings on neonates with perinatal arterial ischaemic stroke (PAIS) have been published elsewhere. 2 In the present study, we describe the findings of neonates diagnosed with PHS.…”

Section: Methodsmentioning

confidence: 94%

“…As described previously, 2 brain imaging was performed on 3T Philips Achieva and 3T Philips Ingenia MR scanners (Philips Medical Systems) at the MR Research Center of Semmelweis University, Budapest, Hungary. The scanning protocol included diffusion‐weighted imaging, conventional T1‐ and T2‐weighted imaging, T2*‐weighted imaging, and susceptibility‐weighted imaging.…”

Section: Methodsmentioning

confidence: 99%

Long‐term neurodevelopmental outcome of neonates born at term with perinatal haemorrhagic stroke: A population‐based study

Vojcek

Gráf

László

et al. 2022

Develop Med Child Neuro

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Stroke is 17 times more common in the perinatal period than at any time later in childhood. 1 Although the aetiology and presentation of perinatal ischaemic stroke are well studied, 2 data on perinatal haemorrhagic stroke (PHS) are limited. PHS is defined as a neonate presenting with neurological symptoms during the first 28 days after delivery with a focal collection of blood within the brain parenchyma. 3 It may occur as a primary haemorrhage with or without a

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Vascular syndrome predicts the development and course of epilepsy after perinatal stroke

Vaher,

Ilves,

Ilves

et al. 2024

Epileptic Disorders

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ObjectiveEpilepsy develops in one third of the patients after perinatal stroke. It is still unclear which vascular syndrome of ischemic stroke carries higher risk of epilepsy. The aim of the current study was to evaluate the risk of epilepsy according to the vascular syndrome of perinatal stroke.MethodsThe study included 39 children with perinatal arterial ischemic stroke (13 with anterior or posterior trunk of the distal middle cerebral artery occlusion, 23 with proximal or distal M1 middle cerebral artery occlusion and three with lenticulostriate arteria infarction), and 44 children with presumed perinatal venous infarction. Magnetic resonance imaging obtained at the chronic stage was used to evaluate the vascular syndrome of stroke.ResultsThe median follow‐up time was 15.1 years (95% CI: 12.4–16.5 years), epilepsy developed in 19/83 (22.9%) patients. The cumulative probability to be without epilepsy at 15 years was 75.4% (95% CI: 65.8–86.4). The probability of having epilepsy was higher in the group of proximal or distal M1 artery occlusion compared to patients with periventricular venous infarction (HR 7.2, 95% CI: 2.5–26, p = .0007). Patients with periventricular venous infarction had significantly more often status epilepticus or spike–wave activation in sleep ≥85% of it compared to patients with anterior or posterior trunk of the distal middle cerebral artery occlusion (OR = 81; 95% CI: 1.3–5046, p = .029).SignificanceThe emphasis of this study is placed on classifying the vascular syndrome of perinatal stroke and on the targeted follow‐up of patients for epilepsy until young adulthood. The risk for having epilepsy after perinatal stroke is the highest in children with proximal or distal M1 middle cerebral artery occlusion. Patients with periventricular venous infarction have a more severe course of epilepsy.

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The role of brain territorial involvement and infection/inflammation in the long-term outcome of neonates with arterial ischemic stroke: A population-based cohort study

Cited by 10 publications

References 42 publications

Mortality and Long-Term Outcome of Neonates with Congenital Heart Disease and Acute Perinatal Stroke: A Population-Based Case-Control Study

Mortality and Long-Term Outcome of Neonates with Congenital Heart Disease and Acute Perinatal Stroke: A Population-Based Case-Control Study

Long‐term neurodevelopmental outcome of neonates born at term with perinatal haemorrhagic stroke: A population‐based study

Vascular syndrome predicts the development and course of epilepsy after perinatal stroke

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