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Song Y, Li S, Hao L, Han Y, Wu W, Fan Y, Gao X, Li X, Ren C, Chen Y. Risk factors of neonatal stroke from different origins: a systematic review and meta-analysis. Eur J Pediatr 2024:10.1007/s00431-024-05531-5. [PMID: 38661815 DOI: 10.1007/s00431-024-05531-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 04/26/2024]
Abstract
Given the persistent ambiguity regarding the etiology of neonatal stroke across diverse origins, our objective was to conduct a comprehensive evaluation of both qualitative and quantitative risk factors. An exhaustive search of eight databases was executed to amass all pertinent observational studies concerning risk factors for neonatal stroke from various origins. Subsequent to independent screening, data extraction, and bias assessment by two researchers, a meta-analysis was conducted utilizing RevMan and Stata software. Nineteen studies, encompassing a total of 30 factors, were incorporated into this analysis. Beyond established risk factors, our investigation unveiled gestational diabetes (OR, 5.51; P < 0.00001), a history of infertility (OR, 2.44; P < 0.05), placenta previa (OR, 3.92; P = 0.02), postdates (OR, 2.07; P = 0.01), preterm labor (OR, 2.32; P < 0.00001), premature rupture of membranes (OR, 3.02; P = 0.007), a prolonged second stage of labor (OR, 3.94; P < 0.00001), and chorioamnionitis (OR, 4.35; P < 0.00001) as potential risk factors for neonatal cerebral arterial ischemic stroke. Additionally, postdates (OR, 4.31; P = 0.003), preterm labor (OR, 1.60; P < 0.00001), an abnormal CTG tracing (OR, 9.32; P < 0.0001), cesarean section (OR, 4.29; P = 0.0004), male gender (OR, 1.73; P = 0.02), and vaginal delivery (OR, 1.39; P < 0.00001) were associated with an elevated risk for neonatal hemorrhagic stroke. CONCLUSIONS This study provides a succinct overview and comparative analysis of maternal, perinatal, and additional risk factors associated with neonatal cerebral artery ischemic stroke and neonatal hemorrhagic stroke, furnishing critical insights for healthcare practitioners involved in the diagnosis and prevention of neonatal stroke. This research also broadens the conceptual framework for future investigations. WHAT IS KNOWN • Research indicates that prenatal, perinatal, and neonatal risk factors can elevate the risk of neonatal arterial ischemic stroke (NAIS). However, the risk factors for neonatal cerebral arterial ischemic stroke remain contentious, and those for neonatal hemorrhagic stroke (NHS) and neonatal cerebral venous sinus thrombosis (CVST) are still not well-defined. WHAT IS NEW • This study is the inaugural comprehensive review and meta-analysis encompassing 19 studies that explore maternal, perinatal, and various risk factors linked to neonatal stroke of differing etiologies. Notably, our analysis elucidates eight risk factors associated with NAIS: gestational diabetes mellitus, a history of infertility, placenta previa, postdates, preterm birth, premature rupture of membranes, a prolonged second stage of labor, and chorioamnionitis. Furthermore, we identify six risk factors correlated with NHS: postdates, preterm birth, an abnormal CTG, the method of delivery, male gender, and vaginal delivery. Additionally, our systematic review delineates risk factors associated with CVST.
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Affiliation(s)
- Yankun Song
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Shangbin Li
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Ling Hao
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Yiwei Han
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Wenhui Wu
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Yuqing Fan
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Xiong Gao
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Xueying Li
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Changjun Ren
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China.
| | - Yuan Chen
- Department of Pediatrics, the Second Hospital of Hebei medical university, Hebei Medical University, Shijiazhuang, 050000, China.
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Costa IS, Vala B, Costa S, Henriques R. Rare cause of jaundice in a term newborn. BMJ Case Rep 2024; 17:e258661. [PMID: 38355207 PMCID: PMC10868289 DOI: 10.1136/bcr-2023-258661] [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] [Indexed: 02/16/2024] Open
Abstract
Neonatal jaundice is a frequently observed occurrence in full-term newborns and typically manifests between 48 and 96 hours following birth. Early-onset jaundice is primarily induced by pathological factors, namely sepsis, hemolysis and an excessive accumulation of bilirubin resulting from the breakdown of red blood cells.We present a case involving a full-term newborn with an uneventful perinatal history, who exhibited jaundice within the initial day of life and was subsequently admitted to the neonatal intensive care unit to commence intensive phototherapy. Initial screenings for sepsis and blood group incompatibility yielded negative results. However, despite 6 hours of phototherapy, the bilirubin levels did not decrease, prompting an investigation into central nervous system haemorrhage, which uncovered the presence of a haemorrhagic stroke.After a worsening in neurological status with neonatal crisis and need for phenobarbital, a life-saving craniotomy was performed. Clinical evolution was good with no additional crisis detected after the early neonatal period and improvement in motor function at 2-month-old follow-up.
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Affiliation(s)
- Inês Silva Costa
- Neonatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
- Pediatrics Department, Centro Hospitalar Tondela Viseu EPE, Viseu, Portugal
| | - Beatriz Vala
- Pediatrics Department, Centro Hospitalar Leiria EPE, Pousos, Portugal
| | - Sofia Costa
- Neonatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Raquel Henriques
- Neonatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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Fortune A, Perkins E, Paize F, Palanisami B, Gladstone M. Managing mothers' and fathers' uncertainty during their journey through early neurodevelopmental follow-up for their high-risk infants-A qualitative account. Child Care Health Dev 2024; 50:e13168. [PMID: 37737651 DOI: 10.1111/cch.13168] [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: 06/27/2022] [Revised: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Early diagnosis of cerebral palsy is possible by 5 months corrected age for 'at-risk' infants, using diagnostic tools such as the Hammersmith Infant Neurological Examination (HINE), Prechtl's General Movements Assessment (GMA) and magnetic resonance imaging (MRI). This is an uncertain and stressful time for parents where provision of appropriate information and support is essential. AIM To explore parents' views and experiences in relation to the new early neurodevelopmental follow-up of 'at-risk' infants. METHODS Thirteen in-depth one-to-one qualitative interviews were conducted by the primary researcher, with eight parents (six mothers and two fathers) of 'at-risk' infants eligible for a follow-up clinic where the GMA and HINE were performed at 12-week corrected age. Interviews used a pre-piloted topic guide and took place before and after the clinic. Interviews were audio-recorded, transcribed verbatim and analysed using inductive coding and thematic analysis using the framework approach. FINDINGS Seven themes were identified: (1) attempting to manage uncertainty, (2) taking priority, (3) trusting professionals, (4) independence in the parent role, (5) feeling understood, (6) patterns of care and (7) individuality. Parents reported experiencing uncertainty about their current situation and future. Adequate preparation for and timing of information are vital. When uncertainty is poorly managed, parents' wellbeing suffers. Individual parents' perspectives and infants' developmental trajectories differ, and information should be tailored specifically for this. CONCLUSION A parent's understanding of the journey through neurodevelopmental care for their high risk infants is initially very limited. Implementing a counselling service for parents to access psychological support and digital reminder system for clinic appointments, as well as providing more tailored information through trusted professionals, could all improve future parents' experiences.
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Affiliation(s)
- Alice Fortune
- Department Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Elizabeth Perkins
- Department of Primary Care and Mental Health, Institute of Population Health, Liverpool, UK
| | - Fauzia Paize
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | | | - Melissa Gladstone
- Department Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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Barsch Bergqvist A, Simatou E, Skiöld B, Mitha A, Bolk J. Term-born infants with a perinatal stroke frequently had seizures and were prescribed anti-seizure medication at discharge. Acta Paediatr 2023; 112:1907-1915. [PMID: 37365777 DOI: 10.1111/apa.16890] [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: 12/13/2022] [Revised: 05/07/2023] [Accepted: 06/26/2023] [Indexed: 06/28/2023]
Abstract
AIM We investigated the prevalence of seizures in term-born infants with a perinatal stroke in Swedish neonatal wards, assessed the anti-seizure medication prescribed and determined the accuracy of diagnostic codes. METHODS This cross-sectional study used data from the Swedish Neonatal Quality Register. The cases were infants born at ≥37 weeks in 2009-2018 and admitted to a neonatal ward in Stockholm County with a stroke diagnosis, confirmed by their medical chart. The controls were all Swedish infants born during those years. RESULTS There were 76 infants with a confirmed perinatal stroke: 51 ischaemic and 25 haemorrhagic. Seizures were documented in 66/76 (87%) of infants with a stroke and 0.2% of the controls. Anti-seizure medication was administered to 64/66 (97%) infants with a stroke and seizures. In 60 cases, the drugs administered were specified, with phenobarbital used in 59/60 cases (98%). More than one drug was administered to 25/60 (42%) infants and 31/60 (52%) were discharged with anti-seizure medication. The positive predictive value for the stroke diagnostic codes was 80.5% (95% CI 76.5-84.5). CONCLUSION Seizures were common in infants with a perinatal stroke. More than one anti-seizure drug was often required and many infants were on anti-seizure medication at discharge, against Swedish recommendations.
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Affiliation(s)
| | - Eleni Simatou
- Department of Child Neurology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Beatrice Skiöld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ayoub Mitha
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- CHU Lille, Paediatric and Neonatal Intensive Care Transport Unit, Department of Emergency Medicine, SAMU 59, Lille University Hospital, Lille, France
| | - Jenny Bolk
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Vasilescu DI, Rosoga AM, Vasilescu S, Dragomir I, Dima V, Dan AM, Cirstoiu MM. SARS-CoV-2 Infection during Pregnancy Followed by Thalamic Neonatal Stroke-Case Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:958. [PMID: 37371190 DOI: 10.3390/children10060958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023]
Abstract
A neonatal stroke is a cerebrovascular process caused by interruption of cerebral blood flow that occurs with an incidence between 1 per 1600 and 1 per 2660 live births. Relative higher incidence in the neonatal period compared to later childhood is favored by the hypercoagulability state of the mother, mechanical stress during delivery, transient right to left intracardiac shunt, high hematocrit, blood viscosity, and risk of dehydration during the first few days of life. The exact cause of a neonatal stroke remains unclear in many cases. About 80% of neonatal strokes are due to arterial ischemic events involving the middle cerebral artery. Typical clinical manifestations in a neonatal stroke are usually seizures that appear immediately after birth or after several days of life, but many of the cases may remain asymptomatic. We present the case of a late preterm infant diagnosed with a thalamic stroke on the fifth day of life with no clinical signs except for repeated episodes of apnea. The anamnesis and clinical context, in this case, revealed a SARS-CoV-2 infection in late pregnancy and early bacterial neonatal sepsis. Early identification of a perinatal stroke and increasing awareness of physicians about this condition in the neonatal period have paramount importance to reduce developmental postischemic damage.
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Affiliation(s)
- Diana Iulia Vasilescu
- Doctoral School, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicineand Pharmacy, 020956 Bucharest, Romania
- Department of Neonatology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Ana Maria Rosoga
- Department of Neonatology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Sorin Vasilescu
- Department of Obstetrics and Gynecology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Ion Dragomir
- Department of Neonatology, Marie Curie Children Hospital, 041451 Bucharest, Romania
| | - Vlad Dima
- Department of Neonatology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
| | - Adriana Mihaela Dan
- Faculty of Medicine, Carol Davila University of Medicineand Pharmacy, 020956 Bucharest, Romania
- Department of Neonatology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Monica Mihaela Cirstoiu
- Faculty of Medicine, Carol Davila University of Medicineand Pharmacy, 020956 Bucharest, Romania
- Department of Obstetrics and Gynecology, Emergency University Hospital, 050098 Bucharest, Romania
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Ozdil M, Cetin ID. A neonatal case of cerebral venous sinus thrombosis with intrauterine onset after COVID-19 infection during pregnancy: Cause or coincidence? J Stroke Cerebrovasc Dis 2023; 32:106922. [PMID: 36493705 PMCID: PMC9715493 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106922] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Coronavirus 19 disease (COVID-19) is known to predispose patients to increased thrombotic events and the risk is higher in pregnancy which is already a hypercoagulable state. Vertical transmission of the disease during pregnancy was neglected according to data early in the pandemic, however, despite conflicting results from different studies, there is an increasing suspicion of vertical transmission with the rise of new fetal and neonatal cases and perinatal transmission can be higher than expected. An early term neonate, with the history of maternal COVID-19 infection in the start of third trimester, was diagnosed as cerebral venous sinus thrombosis and chronic hemorrhagic ischemia, with intrauterine onset.
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Affiliation(s)
- Mine Ozdil
- Department of Pediatrics, Division of Neonatology, Atatürk City Hospital, Balikesir, Turkey,Corresponding author at: Atatürk City Hospital, Neonatal Intensive Care Unit, Gaziosmanpasa, 209/26, 10100, Altieylul, Balikesir, Turkey
| | - Ipek Dokurel Cetin
- Department of Pediatrics, Division of Pediatric Neurology, Atatürk City Hospital, Balikesir, Turkey
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Marchi V, Rizzi R, Nevalainen P, Melani F, Lori S, Antonelli C, Vanhatalo S, Guzzetta A. Asymmetry in sleep spindles and motor outcome in infants with unilateral brain injury. Dev Med Child Neurol 2022; 64:1375-1382. [PMID: 35445398 PMCID: PMC9790667 DOI: 10.1111/dmcn.15244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 12/30/2022]
Abstract
AIM To determine whether interhemispheric difference in sleep spindles in infants with perinatal unilateral brain injury could link to a pathological network reorganization that underpins the development of unilateral cerebral palsy (CP). METHOD This was a multicentre retrospective study of 40 infants (19 females, 21 males) with unilateral brain injury. Sleep spindles were detected and quantified with an automated algorithm from electroencephalograph records performed at 2 months to 5 months of age. The clinical outcomes after 18 months were compared to spindle power asymmetry (SPA) between hemispheres in different brain regions. RESULTS We found a significantly increased SPA in infants who later developed unilateral CP (n=13, with the most robust interhemispheric difference seen in the central spindles. The best individual-level prediction of unilateral CP was seen in the centro-occipital spindles with an overall accuracy of 93%. An empiric cut-off level for SPA at 0.65 gave a positive predictive value of 100% and a negative predictive value of 93% for later development of unilateral CP. INTERPRETATION Our data suggest that automated analysis of interhemispheric SPA provides a potential biomarker of unilateral CP at a very early age. This holds promise for guiding the early diagnostic process in infants with a perinatally identified brain injury. WHAT THIS PAPER ADDS Unilateral perinatal brain injury may affect the development of electroencephalogram (EEG) sleep spindles. Interhemispheric asymmetry in sleep spindles can be quantified with automated EEG analysis. Spindle power asymmetry can be a potential biomarker of unilateral cerebral palsy.
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Affiliation(s)
- Viviana Marchi
- Department of Developmental NeuroscienceIRCCS Stella Maris FoundationPisaItaly
| | - Riccardo Rizzi
- Department of Developmental NeuroscienceIRCCS Stella Maris FoundationPisaItaly,Department of Neuroscience, PsychologyDrug Research and Child Health NEUROFARBA, University of FlorenceFlorenceItaly
| | - Päivi Nevalainen
- Department of Clinical NeurophysiologyChildren's Hospital, HUS Diagnostic Center, Clinical Neurosciences, Helsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Federico Melani
- Neuroscience Department, Children's Hospital MeyerUniversity of FlorenceFlorence
| | - Silvia Lori
- Neurophysiology Unit, Neuro‐Musculo‐Skeletal DepartmentUniversity Hospital CareggiFlorenceItaly
| | - Camilla Antonelli
- Department of Developmental NeuroscienceIRCCS Stella Maris FoundationPisaItaly,Department of Neuroscience, PsychologyDrug Research and Child Health NEUROFARBA, University of FlorenceFlorenceItaly
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology, BABA CenterChildren's Hospital, Neuroscience Center, HiLIFE, Helsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Andrea Guzzetta
- Department of Developmental NeuroscienceIRCCS Stella Maris FoundationPisaItaly,Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
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Kwok TC, Dineen RA, Whitehouse W, Lynn RM, McSweeney N, Sharkey D. Neonatal stroke surveillance study protocol in the United Kingdom and Republic of Ireland. Open Med (Wars) 2022; 17:1417-1424. [PMID: 36128449 PMCID: PMC9449691 DOI: 10.1515/med-2022-0554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/20/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022] Open
Abstract
Neonatal stroke is a devastating condition that causes brain injury in babies and often leads to lifelong neurological impairment. Recent prospective population studies of neonatal stroke are lacking. Neonatal strokes are different from those in older children and adults. A better understanding of its aetiology, current management, and outcomes could reduce the burden of this rare condition. The study aims to explore the incidence and 2 year outcomes of neonatal stroke across an entire population in the UK and Republic of Ireland. This is an active national surveillance study using a purpose-built integrated case notification-data collection online platform. Over a 13 month period, with a potential 6 month extension, clinicians will notify neonatal stroke cases presenting in the first 90 days of life electronically via the online platform monthly. Clinicians will complete a primary questionnaire via the platform detailing clinical information, including neuroimaging, for analysis and classification. An outcome questionnaire will be sent at 2 years of age via the platform. Appropriate ethics and regulatory approvals have been received. The neonatal stroke study represents the first multinational population surveillance study delivered via a purpose-built integrated case notification-data collection online platform and data safe haven, overcoming the challenges of setting up the study.
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Affiliation(s)
- T’ng Chang Kwok
- Centre for Perinatal Research, Population and Lifespan Sciences, School of Medicine, University of Nottingham, Queen’s Medical Centre , Nottingham , NG7 2UH , United Kingdom
| | - Robert A. Dineen
- Radiological Sciences, Mental Health & Clinical Neuroscience, School of Medicine, University of Nottingham, Queen’s Medical Centre , Nottingham , NG7 2UH , United Kingdom
- NIHR Nottingham Biomedical Research Centre , Nottingham , United Kingdom
| | - William Whitehouse
- Centre for Perinatal Research, Population and Lifespan Sciences, School of Medicine, University of Nottingham, Queen’s Medical Centre , Nottingham , NG7 2UH , United Kingdom
| | - Richard M. Lynn
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health , London , WC1N 1EH , England
| | - Niamh McSweeney
- Department of Paediatrics and Child Health, Cork University Hospital, Wilton , Cork , T12 DC4A , Ireland
| | - Don Sharkey
- Centre for Perinatal Research, Population and Lifespan Sciences, School of Medicine, University of Nottingham, E floor, East Block, Queen’s Medical Centre , Nottingham , NG7 2UH , United Kingdom
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Molecular mechanisms underlying some major common risk factors of stroke. Heliyon 2022; 8:e10218. [PMID: 36060992 PMCID: PMC9433609 DOI: 10.1016/j.heliyon.2022.e10218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/10/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
Ischemic and hemorrhagic strokes are the most common known cerebrovascular disease which can be induced by modifiable and non-modifiable risk factors. Age and race are the most common non-modifiable risk factors of stroke. However, hypertension, diabetes, obesity, dyslipidemia, physical inactivity, and cardiovascular disorders are major modifiable risk factors. Understanding the molecular mechanism mediating each of these risk factors is expected to contribute significantly to reducing the risk of stroke, preventing neural damage, enhancing rehabilitation, and designing suitable treatments. Abnormalities in the structure of the blood-brain barrier and blood vessels, thrombosis, vasoconstriction, atherosclerosis, reduced cerebral blood flow, neural oxidative stress, inflammation, and apoptosis, impaired synaptic transmission, excitotoxicity, altered expression/activities of many channels and signaling proteins are the most knows mechanisms responsible for stroke induction. However, the molecular role of risk factors in each of these mechanisms is not well understood and requires a lot of search and reading. This review was designed to provide the reader with a single source of information that discusses the current update of the prevalence, pathophysiology, and all possible molecular mechanisms underlying some major risk factors of stroke namely, hypertension, diabetes mellitus, dyslipidemia, and lipid fraction, and physical inactivity. This provides a full resource for understanding the molecular effect of each of these risk factors in stroke.
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10
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Elgendy MM, Puthuraya S, LoPiccolo C, Liu W, Aly H, Karnati S. Neonatal stroke: Clinical characteristics and neurodevelopmental outcomes. Pediatr Neonatol 2022; 63:41-47. [PMID: 34509386 DOI: 10.1016/j.pedneo.2021.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Neonatal stroke can potentially result in significant neurological sequelae in affected infants. Studies on neurodevelopmental outcomes and the need for rehabilitation therapies in the first two years are limited. We aimed to describe the clinical characteristics, diagnostic evaluation, and neurodevelopmental outcomes of a cohort of infants with neonatal stroke. METHODS A retrospective cohort study of infants with neonatal stroke, from 2011 to 2020. Maternal and infant characteristics were described. Placental pathology, echocardiogram results, and prothrombotic evaluations were reported. The neurodevelopmental outcomes using Bayley scale of infant development (BSID III), rates of epilepsy and cerebral palsy, and the need for rehabilitation therapies at two years were described. RESULTS During the study period, 55 infants had neonatal stroke. Majority (93%) were term or late preterm infants. Maternal chorioamnionitis and perinatal HIE were diagnosed in about a third of the infants. Most (66%) of the infants presented with seizures. On brain MRI, the lesions were unilateral in 76% and arterial in origin in 86% of the infants. Meconium exposure (42%), intrauterine inflammation/infection (37%) and fetal vascular malperfusion (16%) were seen on placental histopathology. At two-year BSID III assessment, median (min, max) composite cognitive, language, and motor scores were 100 (55-145), 97 (47-124), and 100 (46-141), respectively. Among this cohort, epilepsy (27%), cerebral palsy (16%) and the need for rehabilitation therapies (physical -24%, occupational -18%, speech -21%) were reported at two years. CONCLUSION Neonatal stroke presented commonly in term or late preterm infants with seizures. It was unilateral and arterial in origin in most infants. Maternal chorioamnionitis and perinatal HIE were the most commonly associated conditions at birth. About one-fifth of the infants had mild or severe developmental delays at two years. Epilepsy, cerebral palsy, and need for rehabilitation therapies were noted in a significant proportion of infants at two years.
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Affiliation(s)
- Marwa M Elgendy
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Subhash Puthuraya
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Carmela LoPiccolo
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OHio, USA
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Sreenivas Karnati
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA.
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Komuro Y, Galas L, Morozov YM, Fahrion JK, Raoult E, Lebon A, Tilot AK, Kikuchi S, Ohno N, Vaudry D, Rakic P, Komuro H. The Role of Galanin in Cerebellar Granule Cell Migration in the Early Postnatal Mouse during Normal Development and after Injury. J Neurosci 2021; 41:8725-8741. [PMID: 34462307 PMCID: PMC8528496 DOI: 10.1523/jneurosci.0900-15.2021] [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: 03/08/2015] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022] Open
Abstract
Galanin, one of the most inducible neuropeptides, is widely present in developing brains, and its expression is altered by pathologic events (e.g., epilepsy, ischemia, and axotomy). The roles of galanin in brain development under both normal and pathologic conditions have been hypothesized, but the question of how galanin is involved in fetal and early postnatal brain development remains largely unanswered. In this study, using granule cell migration in the cerebellum of early postnatal mice (both sexes) as a model system, we examined the role of galanin in neuronal cell migration during normal development and after brain injury. Here we show that, during normal development, endogenous galanin participates in accelerating granule cell migration via altering the Ca2+ and cAMP signaling pathways. Upon brain injury induced by the application of cold insults, galanin levels decrease at the lesion sites, but increase in the surroundings of lesion sites. Granule cells exhibit the following corresponding changes in migration: (1) slowing down migration at the lesion sites; and (2) accelerating migration in the surroundings of lesion sites. Experimental manipulations of galanin signaling reduce the lesion site-specific changes in granule cell migration, indicating that galanin plays a role in such deficits in neuronal cell migration. The present study suggests that manipulating galanin signaling may be a potential therapeutic target for acutely injured brains during development.SIGNIFICANCE STATEMENT Deficits in neuronal cell migration caused by brain injury result in abnormal development of cortical layers, but the underlying mechanisms remain to be determined. Here, we report that on brain injury, endogenous levels of galanin, a neuropeptide, are altered in a lesion site-specific manner, decreasing at the lesion sites but increasing in the surroundings of lesion sites. The changes in galanin levels positively correlate with the migration rate of immature neurons. Manipulations of galanin signaling ameliorate the effects of injury on neuronal migration and cortical layer development. These results shed a light on galanin as a potential therapeutic target for acutely injured brains during development.
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Affiliation(s)
- Yutaro Komuro
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195
| | - Ludovic Galas
- Regional Platform for Cell Imaging of Normandy, INSERM, Université de Rouen Normandie, 76000 Rouen, France
| | - Yury M Morozov
- Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut 06510
| | - Jennifer K Fahrion
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195
| | - Emilie Raoult
- Regional Platform for Cell Imaging of Normandy, INSERM, Université de Rouen Normandie, 76000 Rouen, France
| | - Alexis Lebon
- Regional Platform for Cell Imaging of Normandy, INSERM, Université de Rouen Normandie, 76000 Rouen, France
| | - Amanda K Tilot
- Department of Genomic Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195
| | - Shin Kikuchi
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195
| | - Nobuhiko Ohno
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195
- Division of Neurobiology and Bioinformatics, National Institute for Physiological Sciences, Aichi 444-8787, Japan
- Department of Anatomy, Division of Histology and Cell Biology, School of Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - David Vaudry
- Regional Platform for Cell Imaging of Normandy, INSERM, Université de Rouen Normandie, 76000 Rouen, France
- Neuropeptides, Neuronal Death and Cell Plasticity Team, Laboratory of Neuronal and Neuroendocrine Communication and Differentiation, INSERM U1239, Université de Rouen Normandie, 76000 Rouen, France
| | - Pasko Rakic
- Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut 06510
- Kavli Institute for Neuroscience, Yale School of Medicine, New Haven, Connecticut 06510
| | - Hitoshi Komuro
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195
- Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut 06510
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12
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Clinical Profile and Long-Term Outcome in Neonatal Cerebral Sinus Venous Thrombosis. Pediatr Neurol 2021; 121:20-25. [PMID: 34126318 DOI: 10.1016/j.pediatrneurol.2021.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Neonatal cerebral sinus venous thrombosis (CSVT) causes high morbidity and mortality. Factors associated with either favorable or unfavorable long-term outcomes have not been clearly established. This study aimed to determine the factors involved in long-term neurological outcomes in patients with neonatal CSVT. METHODS This was a retrospective cohort study of patients with neonatal CSVT at a single institution. Clinical factors associated with long-term neurological outcomes were examined. RESULTS A total of 67 patients met study inclusion criteria for radiologically confirmed neonatal CSVT. The mean patient follow-up duration was four years (range one week to 16 years, median six years). We observed a favorable neurological outcome defined by a pediatric stroke outcome measures (PSOM) score of 0 to 0.5 in 26 (53%) of osurviving patients at follow-up. An unfavorable neurological outcome as defined by PSOM score >0.5 was observed in 23 survivors (47%). Death was reported in 18 (27%) patients, of which 10 patients died due to direct complications of CSVT. Congential heart disease and genetic disease were associated with significantly increased odds for all-cause death. Cardiorespiratory failure and altered mental status during the initial neurological examination were significantly associated with increased odds of death due to CSVT. Among surviving patients, higher PSOM scores were associated with premature birth (i.e., gestational age < 37 weeks), traumatic birth, site of thrombosis in the straight sinus, site of thrombosis in the internal cerebral veins, and hemorrhagic infarct. In contrast, lower PSOM scores were associated with a normal neurological examination at presentation, thrombosis in only superficial sinuses, and hemorrhage without infarct. There was no statistically significant association between the type and duration of CSVT treatment. CONCLUSIONS The major factors influencing outcome of neonates following CSVT included comorbid medical conditions, abnormal neurological examination at presentation, location of venous thrombosis, and type of cerebral injury. These results can help guide further studies in neonatal CSVT aiming to decrease morbidity and mortality with the goal of improving long-term neurological outcomes.
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13
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Sorg AL, Von Kries R, Klemme M, Gerstl L, Beyerlein A, Lack N, Felderhoff-Müser U, Dzietko M. Incidence and risk factors of cerebral sinovenous thrombosis in infants. Dev Med Child Neurol 2021; 63:697-704. [PMID: 33506500 DOI: 10.1111/dmcn.14816] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 12/16/2022]
Abstract
AIM To describe the incidence of term and preterm neonatal cerebral sinovenous thrombosis (CSVT) and identify perinatal risk factors. METHOD This was a national capture-recapture calculation-corrected surveillance and nested case-control study. Infants born preterm and at term with magnetic resonance imaging-confirmed neonatal CSVT were identified by surveillance in all paediatric hospitals in Germany (2015-2017). Incidence was corrected for underreporting using a capture-recapture method in one federal state and then extrapolated nationwide. We reviewed PubMed for comparisons with previously reported incidence estimators. We used a population-based perinatal database for quality assurance to select four controls per case and applied univariate and multivariable regression for risk factor analysis. RESULTS Fifty-one newborn infants (34 males, 17 females; 14 born preterm) with neonatal CSVT were reported in the 3-year period. The incidence of term and preterm neonatal CSVT was 6.6 (95% confidence interval [CI] 4.4-8.7) per 100 000 live births. Median age at time of confirmation of the diagnosis was 9.95 days (range 0-39d). In the univariate analysis, male sex, preterm birth, hypoxia and related indicators (umbilical artery pH <7.1; 5-minute Apgar score <7; intubation/mask ventilation; perinatal asphyxia), operative vaginal delivery, emergency Caesarean section, and pathological fetal Doppler sonography were associated (p<0.05) with neonatal CSVT. Multivariable regression yielded hypoxia (odds ratio=20.3; 95% CI 8.1-50.8) as the independent risk factor. INTERPRETATION Incidence of neonatal CSVT was within the range of other population-based studies. The results suggest that hypoxia is an important perinatal risk factor for the aetiology of neonatal CSVT.
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Affiliation(s)
- Anna-Lisa Sorg
- Institute of Social Paediatrics and Adolescent Medicine, Division of Paediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Rüdiger Von Kries
- Institute of Social Paediatrics and Adolescent Medicine, Division of Paediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mathias Klemme
- Department of Neonatology, University Children's Hospital and Perinatal Centre, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lucia Gerstl
- Department of Paediatric Neurology, University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andreas Beyerlein
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Nicholas Lack
- Bavarian Quality Assurance for In-Patient Medical Care, Munich, Germany
| | | | - Mark Dzietko
- Department of Paediatrics I, Neonatology, University Duisburg-Essen, Essen, Germany
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14
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Why the Hips Remain Stable When the Spine Strays: A Deeper Analysis of the Relationship Between Hip Displacement and Severe Scoliosis in Patients With Cerebral Palsy. J Pediatr Orthop 2021; 41:261-266. [PMID: 33825716 DOI: 10.1097/bpo.0000000000001765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many patients with spastic quadriplegic cerebral palsy (CP) and severe scoliosis develop hip displacement, whereas others do not. We investigated demographic characteristics, risk factors for CP, and imaging findings associated with nondisplaced hips in patients with CP and severe scoliosis. METHODS We retrospectively analyzed records of 229 patients with spastic quadriplegic CP and severe scoliosis who presented for treatment at our US academic tertiary care hospital between August 2005 and September 2015. Demographic characteristics, risk factors for CP, and brain magnetic resonance imaging (MRI) findings were documented. Patients were classified as Gross Motor Function Classification System (GMFCS) level 4 or higher, with 58% at GMFCS level 5.3. Displaced hips (n=181 patients) were defined as a migration percentage of ≥30% or previous surgery for hip displacement/adductor contractures. Patients who did not meet these criteria were classified as nondisplaced (n=48 patients). We used univariate analysis and multivariate logistic regression to determine associations between patient factors and hip displacement (alpha=0.05). RESULTS Patients born at term (≥37 wk) had 2.5 times the odds [95% confidence interval (CI): 1.3-5.0] of having nondisplaced hips compared with patients born prematurely. Females had 2.0 times the odds (95% CI: 1.0-3.9) of having nondisplaced hips compared with males. Patients with normal brain MRI findings had 9.6 times the odds (95% CI: 2.3-41) of having nondisplaced hips compared with patients with abnormal findings. Hip displacement was not associated with race (P>0.05). CONCLUSIONS Gestational age 37 weeks or above, female sex, and normal brain MRI findings are independently associated with nondisplaced hips in patients with spastic quadriplegic CP and severe scoliosis. These findings direct attention to characteristics that may place patients at greater risk of displacement. Future work may influence preventative screening practices and improve patient counseling regarding the risk of hip displacement. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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15
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A Brief Review on Erythropoietin and Mesenchymal Stem Cell Therapies for Paediatric Neurological Disorders. CURRENT STEM CELL REPORTS 2021. [DOI: 10.1007/s40778-021-00189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Larpthaveesarp A, Pathipati P, Ostrin S, Rajah A, Ferriero D, Gonzalez FF. Enhanced Mesenchymal Stromal Cells or Erythropoietin Provide Long-Term Functional Benefit After Neonatal Stroke. Stroke 2021; 52:284-293. [PMID: 33349013 PMCID: PMC7770074 DOI: 10.1161/strokeaha.120.031191] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Perinatal stroke is a common cause of life-long neurobehavioral compromise. Mesenchymal stromal cells (MSCs) and EPO (erythropoietin) have each demonstrated short-term benefit with delayed administration after stroke, and combination therapy may provide the most benefit. The purpose of this study is to determine the long-term histological and functional efficacy of enhanced, intranasal stem cell therapy (MSC preexposed to EPO) compared with standard MSC or multidose systemic EPO. METHODS Transient middle cerebral artery occlusion or sham surgery was performed in postnatal day (P) 10 Sprague-Dawley rats, who were treated with single-dose intranasal MSC, MSC preexposed to EPO (MSC/EPO), multidose systemic EPO (EPO3; 1000 u/kg per dose×3 every 72 hours), or cell-conditioned media on P13 (day 3 [P13-P19] for EPO), or on P17 (day 7 [P17-P23] for EPO). At 2 months of age, animals underwent novel object recognition, cylinder rearing, and open field testing to assess recognition memory, sensorimotor function, and anxiety in adulthood. RESULTS MSC, MSC/EPO, and EPO3 improved brain volume when administered at 3 or 7 days after middle cerebral artery occlusion. MSC/EPO also enhanced long-term recognition memory with either day 3 or day 7 treatment, but EPO3 had the most long-term benefit, improving recognition memory and exploratory behavior and reducing anxiety. CONCLUSIONS These data suggest that single-dose MSC/EPO and multidose systemic EPO improve long-term neurobehavioral outcomes even when administration is delayed, although EPO was the most effective treatment overall. It is possible that EPO represents a final common pathway for improved long-term repair, although the specific mechanisms remain to be determined.
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Affiliation(s)
| | | | - Samuel Ostrin
- Department of Pediatrics, University of California, San Francisco
| | - Anthony Rajah
- Department of Pediatrics, University of California, San Francisco
| | - Donna Ferriero
- Department of Pediatrics, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
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17
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Geraldo AF, Parodi A, Bertamino M, Buffelli F, Uccella S, Tortora D, Moretti P, Ramenghi L, Fulcheri E, Rossi A, Severino M. Perinatal Arterial Ischemic Stroke in Fetal Vascular Malperfusion: A Case Series and Literature Review. AJNR Am J Neuroradiol 2020; 41:2377-2383. [PMID: 33122209 DOI: 10.3174/ajnr.a6857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/17/2020] [Indexed: 11/07/2022]
Abstract
Fetal vascular malperfusion includes a continuum of placental histologic abnormalities increasingly associated with perinatal brain injury, namely arterial ischemic stroke. Here, we describe the clinical-neuroimaging features of 5 neonates with arterial ischemic stroke and histologically proved fetal vascular malperfusion. All infarcts involved the anterior territories and were multiple in 2 patients. In 2 neonates, there were additional signs of marked dural sinus congestion, thrombosis, or both. A mixed pattern of chronic hypoxic-ischemic encephalopathy and acute infarcts was noted in 1 patient at birth. Systemic cardiac or thrombotic complications were present in 2 patients. These peculiar clinical-radiologic patterns may suggest fetal vascular malperfusion and should raise the suspicion of this rare, underdiagnosed condition carrying important implications in patient management, medicolegal actions, and future pregnancy counseling.
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Affiliation(s)
- A F Geraldo
- From the Units of Neuroradiology (A.F.G., D.T., A.R., M.S.).,Diagnostic Neuroradiology Unit (A.F.G.), Imaging Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - A Parodi
- Neonatal Intensive Care (A.P., L.R.)
| | - M Bertamino
- Physical Medicine and Rehabilitation (M.B., P.M.)
| | - F Buffelli
- Gynaecologic and Fetal-Perinatal Pathology (F.B., E.F.)
| | - S Uccella
- Child Neuropsychiatry (S.U.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - D Tortora
- From the Units of Neuroradiology (A.F.G., D.T., A.R., M.S.)
| | - P Moretti
- Physical Medicine and Rehabilitation (M.B., P.M.)
| | - L Ramenghi
- Neonatal Intensive Care (A.P., L.R.).,Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (L.R.)
| | - E Fulcheri
- Gynaecologic and Fetal-Perinatal Pathology (F.B., E.F.).,Surgical Sciences and Integrated Diagnostics, Pathology Division of Anatomic Pathology (E.F.)
| | - A Rossi
- From the Units of Neuroradiology (A.F.G., D.T., A.R., M.S.).,Health Sciences (DISSAL) (A.R.), University of Genoa, Genoa, Italy
| | - M Severino
- From the Units of Neuroradiology (A.F.G., D.T., A.R., M.S.)
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18
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Khan MH, Smithson L, Li E, Kirton A, Pei J, Andersen J, Yager JY, Brooks BL, Rasmussen C. Executive behavior and functional abilities in children with perinatal stroke and the associated caregiver impact. Child Neuropsychol 2020; 27:83-95. [PMID: 32718269 DOI: 10.1080/09297049.2020.1796953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Perinatal stroke is the most common form of stroke in childhood and is followed by a variety of outcomes, with many children experiencing specific functional and neuropsychological deficits. The association of these outcomes with the psychosocial impact caregivers face is not well documented. The goal of our pilot study was to examine caregivers' perception of executive behavior and functional abilities among children with perinatal stroke, and how these outcomes impact the caregivers. We administered three questionnaires to primary caregivers of children with perinatal stroke to obtain caregiver-reported measures of (1) executive behavior of their child (Behavior Rating Inventory of Executive Function, Second Edition), (2) the functional abilities of their child (Pediatric Evaluation of Disability Inventory Computer Adaptive Test), and (3) the psychosocial impact experienced by the caregiver themselves (Parental Outcome Measure). Participants included 20 children (mean age = 9.3 years, range = 6-16 years) with perinatal stroke and their primary caregivers. Functional abilities in the children were rated as clinically impaired in the domains of daily activities and mobility. Half of the children exhibited clinically impaired ratings on at least one executive behavior domain, but the mean scores for these domains did not reach clinically impaired levels. Greater ratings of problems in daily activities for the child was associated with greater caregiver guilt (r = -0.55, p = 0.02). Caregivers of children with perinatal stroke who experience limitations in performing daily activities should be more closely monitored for adverse impact and be provided the necessary support and education to alleviate the associated guilt.
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Affiliation(s)
- Muhammad H Khan
- Department of Pediatrics, University of Alberta , Edmonton, Canada
| | - Lisa Smithson
- Department of Pediatrics, University of Calgary , Calgary, Canada
| | - Eliza Li
- Department of Educational Psychology, University of Alberta , Edmonton, Canada
| | - Adam Kirton
- Department of Pediatrics, University of Calgary , Calgary, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta , Edmonton, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta , Edmonton, Canada.,Section of Pediatric Neurosciences, Stollery Children's Hospital , Edmonton, Canada.,Child Health, Glenrose Rehabilitation Hospital , Edmonton, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta , Edmonton, Canada.,Section of Pediatric Neurosciences, Stollery Children's Hospital , Edmonton, Canada
| | - Brian L Brooks
- Department of Pediatrics, University of Calgary , Calgary, Canada.,Neuropsychology Service, Alberta Children's Hospital , Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine , Calgary, Canada.,Department of Psychology, University of Calgary , Calgary, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta , Edmonton, Canada
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19
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Gerner GJ, Newman EI, Burton VJ, Roman B, Cristofalo EA, Leppert M, Johnston MV, Northington FJ, Huisman TA, Poretti A. Correlation Between White Matter Injury Identified by Neonatal Diffusion Tensor Imaging and Neurodevelopmental Outcomes Following Term Neonatal Asphyxia and Therapeutic Hypothermia: An Exploratory Pilot Study. J Child Neurol 2019; 34:556-566. [PMID: 31070085 PMCID: PMC7318916 DOI: 10.1177/0883073819841717] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Hypoxic-ischemic encephalopathy is associated with damage to deep gray matter; however, white matter involvement has become recognized. This study explored differences between patients and clinical controls on diffusion tensor imaging, and relationships between diffusion tensor imaging and neurodevelopmental outcomes. METHOD Diffusion tensor imaging was obtained for 31 neonates after hypoxic-ischemic encephalopathy treated with therapeutic hypothermia and 10 clinical controls. A subgroup of patients with hypoxic-ischemic encephalopathy (n = 14) had neurodevelopmental outcomes correlated with diffusion tensor imaging scalars. RESULTS Group differences in diffusion tensor imaging scalars were observed in the putamen, anterior and posterior centrum semiovale, and the splenium of the corpus callosum. Differences in these regions of interest were correlated with neurodevelopmental outcomes between ages 20 and 32 months. CONCLUSION Therapeutic hypothermia may not be a complete intervention for hypoxic-ischemic encephalopathy, as neonatal white matter changes may continue to be evident, but further research is warranted. Patterns of white matter change on neonatal diffusion tensor imaging correlated with neurodevelopmental outcomes in this exploratory pilot study.
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Affiliation(s)
- Gwendolyn J. Gerner
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD USA
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Eric I. Newman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science
| | - V. Joanna Burton
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD USA
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Brenton Roman
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD USA
| | - Elizabeth A. Cristofalo
- Frederick Memorial Hospital, Department of Neonatology, Frederick, MD, USA
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Mary Leppert
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD USA
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Michael V. Johnston
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD USA
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD USA
- Hugo Moser Research Institute, Kennedy Krieger Institute, Baltimore, MD USA
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Frances J. Northington
- Department of Perinatal-Neonatal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Thierry A.G.M. Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Andrea Poretti
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD USA
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
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20
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Wagenaar N, van den Berk DJM, Lemmers PMA, van der Aa NE, Dudink J, van Bel F, Groenendaal F, de Vries LS, Benders MJNL, Alderliesten T. Brain Activity and Cerebral Oxygenation After Perinatal Arterial Ischemic Stroke Are Associated With Neurodevelopment. Stroke 2019; 50:2668-2676. [PMID: 31390967 PMCID: PMC6756254 DOI: 10.1161/strokeaha.119.025346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Supplemental Digital Content is available in the text. In infants with perinatal arterial ischemic stroke (PAIS), early prognosis of neurodevelopmental outcome is important to adequately inform parents and caretakers. Early continuous neuromonitoring after PAIS may improve early prognosis. Our aim was to study early cerebral electrical activity and oxygenation measured by amplitude-integrated electroencephalography (aEEG) and near-infrared spectroscopy in term neonates with PAIS and relate these to the development of cerebral palsy and cognitive deficit.
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Affiliation(s)
- Nienke Wagenaar
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Daphne J M van den Berk
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Petra M A Lemmers
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Niek E van der Aa
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Jeroen Dudink
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Frank van Bel
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Floris Groenendaal
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Linda S de Vries
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Manon J N L Benders
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Thomas Alderliesten
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands.,University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
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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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22
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Nevalainen P, Metsäranta M, Toiviainen-Salo S, Lönnqvist T, Vanhatalo S, Lauronen L. Bedside neurophysiological tests can identify neonates with stroke leading to cerebral palsy. Clin Neurophysiol 2019; 130:759-766. [PMID: 30904770 DOI: 10.1016/j.clinph.2019.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/30/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The unspecific symptoms of neonatal stroke still challenge its bedside diagnosis. We studied the accuracy of routine electroencephalography (EEG) and simultaneously recorded somatosensory evoked potentials (EEG-SEP) for diagnosis and outcome prediction of neonatal stroke. METHODS We evaluated EEG and EEG-SEPs from a hospital cohort of 174 near-term neonates with suspected seizures or encephalopathy, 32 of whom were diagnosed with acute ischemic or hemorrhagic stroke in MRI. EEG was scored for background activity and seizures. SEPs were classified as present or absent. Developmental outcome of stroke survivors was evaluated from medical records at 8- to 18-months age. RESULTS The combination of continuous EEG and uni- or bilaterally absent SEP (n = 10) was exclusively seen in neonates with a middle cerebral artery (MCA) stroke (specificity 100%). Moreover, 80% of the neonates with this finding developed with cerebral palsy. Bilaterally present SEPs did not exclude stroke, but predicted favorable neuromotor outcome in stroke survivors (positive predictive value 95%). CONCLUSIONS Absent SEP combined with continuous EEG background in near-term neonates indicates an MCA stroke and a high risk for cerebral palsy. SIGNIFICANCE EEG-SEP offers a bedside method for diagnostic screening and a reliable prediction of neuromotor outcome in neonates suspected of having a stroke.
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Affiliation(s)
- Päivi Nevalainen
- Department of Clinical Neurophysiology, Children's Hospital, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland.
| | - Marjo Metsäranta
- Department of Pediatrics, Children's Hospital, University of Helsinki and HUH, Helsinki, Finland
| | - Sanna Toiviainen-Salo
- Department of Pediatric Radiology, Children's Hospital, HUS Medical Imaging Center, Radiology, University of Helsinki and HUH, Helsinki, Finland
| | - Tuula Lönnqvist
- Department of Child Neurology, Children's Hospital, University of Helsinki and HUH, Helsinki, Finland
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology, Children's Hospital, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
| | - Leena Lauronen
- Department of Clinical Neurophysiology, Children's Hospital, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
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23
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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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Abstract
Cerebral sinovenous thrombosis (CSVT) is a focal or diffuse disruption of cerebral blood flow secondary to occlusion of cerebral veins and/or sinuses. The challenge of CSVT during the neonatal age has led to a great interest in this condition among neonatologists, child neurologists, and pediatric neuroradiologists. The highly variable clinical spectra, etiologies, and prognosis require fine medical skills and a high level of suspicion. Nevertheless, the diagnosis is often delayed or missed altogether. Differences in brain vulnerability at different stages of maturation may explain the spectrum of associated brain lesions, which varies with gestational age. Treatment is controversial and reported clinical outcomes vary widely. The controversial treatment of CSVT with anticoagulant therapy is based only on case series and expert consensus, there is lack of safety data.
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Affiliation(s)
- Luca A Ramenghi
- Neonatal Intensive Care Unit, Giannina Gaslini Children's Hospital, Genova, Italy.
| | - Valentina Cardiello
- Neonatal Intensive Care Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Andrea Rossi
- Neonatal Intensive Care Unit, Giannina Gaslini Children's Hospital, Genova, Italy
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25
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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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Tan AP, Svrckova P, Cowan F, Chong WK, Mankad K. Intracranial hemorrhage in neonates: A review of etiologies, patterns and predicted clinical outcomes. Eur J Paediatr Neurol 2018; 22:690-717. [PMID: 29731328 DOI: 10.1016/j.ejpn.2018.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 03/31/2018] [Accepted: 04/18/2018] [Indexed: 12/29/2022]
Abstract
Intracranial hemorrhage (ICH) in neonates often results in devastating neurodevelopmental outcomes as the neonatal period is a critical window for brain development. The neurodevelopmental outcomes in neonates with ICH are determined by the maturity of the brain, the location and extent of the hemorrhage, the specific underlying etiology and the presence of other concomitant disorders. Neonatal ICH may result from various inherited and acquired disorders. We classify the etiologies of neonatal ICH into eight main categories: (1) Hemorrhagic stroke including large focal hematoma, (2) Prematurity-related hemorrhage, (3) Bleeding diathesis, (4) Genetic causes, (5) Infection, (6) Trauma-related hemorrhage, (7) Tumor-related hemorrhage and (8) Vascular malformations. Illustrative cases showing various imaging patterns that can be helpful to predict clinical outcomes will be highlighted. Potential mimics of ICH in the neonatal period are also reviewed.
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Affiliation(s)
- Ai Peng Tan
- Department of Diagnostic Imaging, National University Health System, 1E Kent Ridge Rd 119228, Singapore.
| | - Patricia Svrckova
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK.
| | - Frances Cowan
- Dept. of Neonatology, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College, London, SW10 9NH, UK.
| | - Wui Khean Chong
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK.
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK.
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Mühlbacher T, Bohner G, Bührer C, Dame C. Cerebellar Infarction: Unusual Manifestation with Facial Palsy, Focal Seizures, and Secondary Generalization. Neonatology 2018; 113:33-36. [PMID: 28946144 DOI: 10.1159/000480423] [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] [Received: 04/26/2017] [Accepted: 08/18/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cerebellar infarction is exceedingly rare in neonates, usually occurring after traumatic birth. Lifelong sequelae can result from cerebellar damage with disorders of motor function, ataxia, and also cognitive dysfunction. OBJECTIVES/METHODS We report the clinical presentation of a preterm triplet infant delivered by elective cesarean who showed peripheral facial palsy immediately after birth. RESULTS Tonic seizures with high-voltage discharges over the contralateral cerebral hemisphere and secondary generalization were successfully treated with phenobarbital. Transnuchal ultrasound through the foramen magnum and subsequent MRI examinations revealed infarction of the left cerebellar hemisphere. CONCLUSIONS In newborn infants, acute cerebellar stroke may have direct epileptogenic potential.
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Affiliation(s)
- Tobias Mühlbacher
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Li C, Miao JK, Xu Y, Hua YY, Ma Q, Zhou LL, Liu HJ, Chen QX. Prenatal, perinatal and neonatal risk factors for perinatal arterial ischaemic stroke: a systematic review and meta-analysis. Eur J Neurol 2017. [PMID: 28646492 DOI: 10.1111/ene.13337] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Li
- Department of Neonatology; Ministry of Education Key Laboratory of Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
| | - J. K. Miao
- Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
| | - Y. Xu
- Department of Neonatology; Chongqing Health Center for Women and Children; Chongqing China
| | - Y. Y. Hua
- Department of Neonatology; Ministry of Education Key Laboratory of Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
| | - Q. Ma
- Department of Neonatology; Ministry of Education Key Laboratory of Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
| | - L. L. Zhou
- Department of Neonatology; Ministry of Education Key Laboratory of Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
| | - H. J. Liu
- Department of Neonatology; Ministry of Education Key Laboratory of Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
| | - Q. X. Chen
- Department of Neonatology; Ministry of Education Key Laboratory of Child Development and Disorders; Children's Hospital of Chongqing Medical University; Chongqing China
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Larpthaveesarp A, Gonzalez FF. Transient Middle Cerebral Artery Occlusion Model of Neonatal Stroke in P10 Rats. JOURNAL OF VISUALIZED EXPERIMENTS : JOVE 2017:54830. [PMID: 28518065 PMCID: PMC5565067 DOI: 10.3791/54830] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
A number of animal models have been used to study hypoxic-ischemic injury, traumatic injury, global hypoxia, or permanent ischemia in both the immature and mature brain. Stroke occurs commonly in the perinatal period in humans, and transient ischemia-reperfusion is the most common form of stroke in neonates. The reperfusion phase is a critical component of injury progression, which occurs over a period of days to weeks, and of the endogenous response to injury. This postnatal day 10 (p10) rat model of transient middle cerebral artery occlusion (tMCAO) creates a unilateral, non-hemorrhagic focal ischemia-reperfusion injury that can be utilized to study the mechanisms of focal injury and repair in the full-term-equivalent brain. The injury pattern that is produced by tMCAO is consistent and highly reproducible and can be confirmed with MRI or histological analyses. The severity of injury can be manipulated through changes in occlusion time and other methods that will be discussed.
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Cannabidiol reduces brain damage and improves functional recovery in a neonatal rat model of arterial ischemic stroke. Neuropharmacology 2017; 116:151-159. [DOI: 10.1016/j.neuropharm.2016.12.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 12/22/2022]
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Variability in Clinical Presentation of Neonatal Stroke: Report of Four Cases. Case Rep Neurol Med 2017; 2017:5215686. [PMID: 28194288 PMCID: PMC5282426 DOI: 10.1155/2017/5215686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/12/2016] [Indexed: 11/17/2022] Open
Abstract
Neonatal stroke can be a cause of long term neurodevelopmental disability, seizures, and impaired cognitive function. We present four cases of neonatal stroke, associated with different risk factors and clinical presentations. Two of these newborns were born to mothers with no prenatal care.
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Romantsik O, Bruschettini M, Zappettini S, Ramenghi LA, Calevo MG. Heparin for the treatment of thrombosis in neonates. Cochrane Database Syst Rev 2016; 11:CD012185. [PMID: 27820879 PMCID: PMC6464761 DOI: 10.1002/14651858.cd012185.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Among pediatric patients, newborns are at highest risk of developing thromboembolism. Neonatal thromboembolic (TE) events may consist of both venous and arterial thromboses and often iatrogenic complications (eg, central catheterization). Treatment guidelines for pediatric patients with TE events most often are extrapolated from the literature regarding adults. Options for the management of neonatal TE events include expectant management; nitroglycerin ointment; thrombolytic therapy or anticoagulant therapy, or a combination of the two; and surgery. Since the 1990s, low molecular weight heparin (LMWH) has become the neonatal anticoagulant of choice. Reasons for its appeal include predictable dose response, no need for venous access, and limited monitoring requirements. The overall major complication rate is around 5%. Whether preterm infants are at increased risk is unclear. No data are available on the frequency of osteoporosis, heparin-induced thrombocytopenia (HIT), or other hypersensitivity reactions in children and neonates exposed to LMWH. OBJECTIVES To assess whether heparin treatment (both unfractionated heparin [UFH] and LMWH) reduces mortality and morbidity rates in preterm and term newborn infants with diagnosed thrombosis. The intervention is compared with placebo or no treatment. Also, to assess the safety of heparin therapy (both UFH and LMWH) for potential harms.Subgroup analyses were planned to examine gestational age, birth weight, mode of thrombus diagnosis, presence of a central line, positive family history for genetic disorders (thrombophilia, deficiency of protein S and protein C, methylenetetrahydrofolate reductase [MTHFR] mutation), route of heparin administration, type of heparin used, and location of thrombus (see "Subgroup analysis and investigation of heterogeneity"). SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 4), MEDLINE via PubMed (1966 to May 9, 2016), Embase (1980 to May 9, 2016), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to May 9, 2016). We searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. SELECTION CRITERIA Randomized, quasi-randomized, and cluster-randomized controlled trials comparing heparin versus placebo or no treatment in preterm and term neonates with a diagnosis of thrombosis. DATA COLLECTION AND ANALYSIS We used the standard methods of the Cochrane Neonatal Review Group. Two review authors independently assessed studies identified by the search strategy for inclusion. MAIN RESULTS Our search strategy yielded 1160 references. Two review authors independently assessed all references for inclusion. We found no completed studies and no ongoing trials for inclusion. AUTHORS' CONCLUSIONS We found no studies that met our inclusion criteria and no evidence from randomized controlled trials to recommend or refute the use of heparin for treatment of neonates with thrombosis.
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Affiliation(s)
- Olga Romantsik
- Lund University, Skane University HospitalDepartment of PaediatricsLundSweden
| | - Matteo Bruschettini
- Lund University, Skane University HospitalDepartment of PaediatricsLundSweden
| | | | | | - Maria Grazia Calevo
- Istituto Giannina GasliniEpidemiology, Biostatistics and Committees UnitGenoaItaly16147
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Middle Cerebral Artery Stroke in a Neonate With a Congenital Hypercoagulable Condition Following Repair of an H-type Tracheoesophageal Fistula. J Pediatr Hematol Oncol 2016; 38:529-32. [PMID: 27164518 DOI: 10.1097/mph.0000000000000580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of middle cerebral artery stroke with heterozygosity for 2 separate hypercoagulable conditions following repair of an H-type tracheoesophageal fistula (TEF) in an infant. Neonatal stroke is rare, occurring in 1 in 4000 births annually in the United States. Stroke after pediatric surgery occurs in approximately 0.05% of patients. Etiologies of stroke in neonates include cardiac, hematologic, vascular, traumatic, metabolic, pharmacologic, infectious, and hypoxemic insults. Thrombophilia has been described in 42% to 78% of neonates with neonatal stroke. Stroke after repair of an H-type TEF has not been reported as a postoperative complication. Manipulation of the carotid artery during this operation is presumed to have contributed to a thromboembolic event in this infant with a hypercoagulable state. Whereas preoperative workup may not be indicated due to the low prevalence of neonatal stroke, workup for a congenital hypercoaguable condition may be considered in infants with stroke as a postoperative complication. This report provides a concise review of the etiology and treatment of stroke and hypercoagulable states in neonates as well as presents the case of a previously undescribed complication of repair of an H-type TEF.
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Fluss J, Garcia-Tarodo S, Granier M, Villega F, Ferey S, Husson B, Kossorotoff M, Muehlethaler V, Lebon S, Chabrier S. Perinatal arterial ischemic stroke related to carotid artery occlusion. Eur J Paediatr Neurol 2016; 20:639-48. [PMID: 27025300 DOI: 10.1016/j.ejpn.2016.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/02/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aetiology of perinatal arterial ischemic stroke remains speculative. It is however widely accepted that the aetiology is multifactorial, involving various maternal, placental, foetal and neonatal risk factors. A resulting thromboembolic process is hypothesized and the placenta identified as the most plausible source. An arteriopathy, as observed in a significant proportion of childhood ischemic stroke, is thought to be rare. METHODS We report here five cases of perinatal stroke that differ from the vast majority by documented carotid occlusion, and add eleven other similar cases from the literature. RESULTS In the majority, an intraluminal thrombus of placental origin is the most probable hypothesis, while in the remaining ones, one can reasonably presume a direct vessel wall injury related to a traumatic delivery, yet generally unproven by imaging. CONCLUSION We hypothesize that most of these cases share similar pathophysiology with the more common perinatal arterial ischemic stroke but differ by a persistent identified thrombus in the carotid artery at the time of first imaging, leading to a more severe and extended ischemic damage responsible for an adverse neurological outcome.
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Affiliation(s)
- Joel Fluss
- Pediatric Neurology Unit, Pediatric Subspecialities Service, Children's Hospital, Geneva University Hospitals, Switzerland.
| | - Stephanie Garcia-Tarodo
- Pediatric Neurology Unit, Pediatric Subspecialities Service, Children's Hospital, Geneva University Hospitals, Switzerland
| | - Michèle Granier
- Neonatal Unit, Sud-Francilien Hospital Centre, Corbeil, France
| | - Frédéric Villega
- Pediatric Neurology, Children's Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Solène Ferey
- Unit of Pediatric Radiology, Children's Hospital, Geneva University Hospitals, Switzerland
| | - Béatrice Husson
- French Centre for Pediatric Stroke and Pediatric Radiology, Bicêtre University Hospital Centre, Le Kremlin-Bicêtre, France
| | - Manoelle Kossorotoff
- French Centre for Pediatric Stroke, Pediatric Neurology Department, APHP-Necker-Enfants Malades, University Hospital, Paris, France
| | - Vincent Muehlethaler
- Neonatal Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Sebastien Lebon
- Pediatric Neurology Unit, Department of Pediatrics, Lausanne University Hospital, Switzerland
| | - Stéphane Chabrier
- French Centre for Pediatric Stroke, University Hospital Centre of Saint-Etienne, 42055 Saint-Etienne Cedex 2, France
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Husson B, Hertz-Pannier L, Adamsbaum C, Renaud C, Presles E, Dinomais M, Kossorotoff M, Landrieu P, Chabrier S. MR angiography findings in infants with neonatal arterial ischemic stroke in the middle cerebral artery territory: A prospective study using circle of Willis MR angiography. Eur J Radiol 2016; 85:1329-35. [DOI: 10.1016/j.ejrad.2016.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 11/29/2022]
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Romantsik O, Bruschettini M, Zappettini S, Ramenghi LA, Calevo MG. Heparin for the treatment of thrombosis in preterm and term neonates. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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37
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Larpthaveesarp A, Georgevits M, Ferriero DM, Gonzalez FF. Delayed erythropoietin therapy improves histological and behavioral outcomes after transient neonatal stroke. Neurobiol Dis 2016; 93:57-63. [PMID: 27142685 DOI: 10.1016/j.nbd.2016.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/06/2016] [Accepted: 04/29/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND PURPOSE Stroke is a major cause of neonatal morbidity, often with delayed diagnosis and with no accepted therapeutic options. The purpose of this study is to investigate the efficacy of delayed initiation of multiple dose erythropoietin (EPO) therapy in improving histological and behavioral outcomes after early transient ischemic stroke. METHODS 32 postnatal day 10 (P10) Sprague-Dawley rats underwent sham surgery or transient middle cerebral artery occlusion (tMCAO) for 3h, resulting in injury involving the striatum and parieto-temporal cortex. EPO (1000U/kg per dose×3 doses) or vehicle was administered intraperitoneally starting one week after tMCAO (at P17, P20, and P23). At four weeks after tMCAO, sensorimotor function was assessed in these four groups (6 vehicle-sham, 6 EPO-sham, 10 vehicle-tMCAO and 10 EPO-tMCAO) with forepaw preference in cylinder rearing trials. Brains were then harvested for hemispheric volume and Western blot analysis. RESULTS EPO-tMCAO animals had significant improvement in forepaw symmetry in cylinder rearing trials compared to vehicle-tMCAO animals, and did not differ from sham animals. There was also significant preservation of hemispheric brain volume in EPO-tMCAO compared to vehicle-tMCAO animals. No differences in ongoing cell death at P17 or P24 were noted by spectrin cleavage in either EPO-tMCAO or vehicle-tMCAO groups. CONCLUSIONS These results suggest that delayed EPO therapy improves both behavioral and histological outcomes at one month following transient neonatal stroke, and may provide a late treatment alternative for early brain injury.
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Affiliation(s)
- Amara Larpthaveesarp
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143, United States
| | - Margaret Georgevits
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143, United States
| | - Donna M Ferriero
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143, United States; Department of Neurology, University of California San Francisco, San Francisco, CA 94143, United States
| | - Fernando F Gonzalez
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143, United States.
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Ilves P, Laugesaar R, Loorits D, Kolk A, Tomberg T, Lõo S, Talvik I, Kahre T, Talvik T. Presumed Perinatal Stroke: Risk Factors, Clinical and Radiological Findings. J Child Neurol 2016; 31:621-8. [PMID: 26446909 DOI: 10.1177/0883073815609149] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 08/22/2015] [Indexed: 12/28/2022]
Abstract
It is unknown why some infants with perinatal stroke present clinical symptoms late during infancy and will be identified as infants with presumed perinatal stroke. The risk factors and clinical and radiological data of 42 infants with presumed perinatal stroke (69% with periventricular venous infarction and 31% with arterial ischemic stroke) from the Estonian Pediatric Stroke Database were reviewed. Children with presumed perinatal stroke were born at term in 95% of the cases and had had no risk factors during pregnancy in 43% of the cases. Children with periventricular venous infarction were born significantly more often (82%) vaginally (P = .0213) compared to children with arterial stroke (42%); nor did they require resuscitation (P = .0212) or had any neurological symptoms after birth (P = .0249). Periventricular venous infarction is the most common type of lesion among infants with the presumed perinatal stroke. Data suggest that the disease is of prenatal origin.
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Affiliation(s)
- Pilvi Ilves
- Radiology Clinic of Tartu University Hospital, Tartu, Estonia Department of Radiology, University of Tartu, Tartu, Estonia
| | - Rael Laugesaar
- Department of Pediatrics, University of Tartu, Tartu, Estonia Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Dagmar Loorits
- Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Anneli Kolk
- Department of Pediatrics, University of Tartu, Tartu, Estonia Department of Neurology and Neurorehabilitation, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Tiiu Tomberg
- Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Silva Lõo
- Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Inga Talvik
- Department of Pediatrics, University of Tartu, Tartu, Estonia Department of Neurology and Neurorehabilitation, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Tiina Kahre
- Department of Genetics, United Laboratories of Tartu University Hospital, Tartu, Estonia
| | - Tiina Talvik
- Department of Pediatrics, University of Tartu, Tartu, Estonia Children's Clinic of Tartu University Hospital, Tartu, Estonia
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Garfinkle J, Wintermark P, Shevell MI, Oskoui M. Cerebral palsy after neonatal encephalopathy: do neonates with suspected asphyxia have worse outcomes? Dev Med Child Neurol 2016; 58:189-94. [PMID: 26555029 DOI: 10.1111/dmcn.12953] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 11/26/2022]
Abstract
AIM We sought to investigate how brain injury and severity, and neurological subtype of cerebral palsy (CP) differed in term-born children with CP after neonatal encephalopathy, between those with suspected birth asphyxia and those without. METHOD Using the Canadian CP Registry, which included 1001 children, those with CP born at ≥ 36 wks after moderate or severe neonatal encephalopathy, were dichotomized according to the presence or absence of suspected birth asphyxia. Gross Motor Function Classification System (GMFCS) scores, neurological subtypes, comorbidities, and magnetic resonance imaging findings were compared. RESULTS Of the 147 term-born children with CP (82 males, 65 females; median age 37 months, interquartile range [IQR] 26-52.5) who after moderate or severe neonatal encephalopathy had the required outcome data, 61 (41%) met criteria for suspected birth asphyxia. They had a higher frequency of non-ambulatory GMFCS status (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.72-6.8), spastic quadriplegia (OR 2.8, 95% CI 1.4-5.6), non-verbal communication skills impairment (OR 4.2, 95% CI 2.0-8.6), isolated deep grey matter injury (OR 4.1, 95% CI 1.8-9.5), a lower frequency of spastic hemiplegia (OR 0.17, 95% CI 0.07-0.42), focal injury (OR 0.20; 95% CI 0.04-0.93), and more comorbidities (p=0.017) than those who did not meet criteria. INTERPRETATION Term-born children who develop CP after neonatal encephalopathy with suspected birth asphyxia have a greater burden of disability than those without suspected birth asphyxia.
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Affiliation(s)
- Jarred Garfinkle
- Department of Pediatrics, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada
| | - Pia Wintermark
- Department of Pediatrics, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.,Division of Neonatology, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada
| | - Michael I Shevell
- Department of Pediatrics, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.,Department of Neurology/Neurosurgery, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.,Division of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada
| | - Maryam Oskoui
- Department of Pediatrics, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.,Department of Neurology/Neurosurgery, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada.,Division of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, QC, Canada
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40
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Machado V, Pimentel S, Pinto F, Nona J. Perinatal ischemic stroke: a five-year retrospective study in a level-III maternity. EINSTEIN-SAO PAULO 2015; 13:65-71. [PMID: 25993071 PMCID: PMC4946814 DOI: 10.1590/s1679-45082015ao3056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 01/07/2015] [Indexed: 12/04/2022] Open
Abstract
Objective To study the incidence, clinical presentation, risk factors, imaging diagnosis, and clinical outcome of perinatal stroke. Methods Data was retrospectively collected from full-term newborns admitted to the neonatal unit of a level III maternity in Lisbon with cerebral stroke, from January 2007 to December 2011. Results There were 11 cases of stroke: nine were arterial ischemic stroke and two were cerebral venous sinus thrombosis. We estimated an incidence of arterial ischemic stroke of 1.6/5,000 births and of cerebral venous sinus thrombosis of 7.2/100,000 births. There were two cases of recurrent stroke. Eight patients presented with symptoms while the remaining three were asymptomatic and incidentally diagnosed. The most frequently registered symptoms (8/11) were seizures; in that, generalized clonic (3/8) and focal clonic (5/8). Strokes were more commonly left-sided (9/11), and the most affected artery was the left middle cerebral artery (8/11). Transfontanelle ultrasound was positive in most of the patients (10/11), and stroke was confirmed by cerebral magnetic resonance in all patients. Electroencephalographic recordings were carried out in five patients and were abnormal in three (focal abnormalities n=2, burst-suppression pattern n=1). Eight patients had previously identified risk factors for neonatal stroke which included obstetric and neonatal causes. Ten patients were followed up at outpatients setting; four patients developed motor deficits and one presented with epilepsy. Conclusions Although a modest and heterogeneous sample, this study emphasizes the need for a high level of suspicion when it comes to neonatal stroke, primarily in the presence of risk factors. The prevalence of neurological sequelae in our series supports the need of long-term follow-up and early intervention strategies.
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Affiliation(s)
| | | | | | - José Nona
- Maternidade Dr. Alfredo da Costa, Lisboa, Portugal
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41
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Dinomais M, Hertz-Pannier L, Groeschel S, Chabrier S, Delion M, Husson B, Kossorotoff M, Renaud C, Nguyen The Tich S. Long term motor function after neonatal stroke: Lesion localization above all. Hum Brain Mapp 2015; 36:4793-807. [PMID: 26512551 DOI: 10.1002/hbm.22950] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 12/21/2022] Open
Abstract
Motor outcome is variable following neonatal arterial ischemic stroke (NAIS). We analyzed the relationship between lesion characteristics on brain MRI and motor function in children who had suffered from NAIS. Thirty eight full term born children with unilateral NAIS were investigated at the age of seven. 3D T1- and 3D FLAIR-weighted MR images were acquired on a 3T MRI scanner. Lesion characteristics were compared between patients with and without cerebral palsy (CP) using the following approaches: lesion localization either using a category-based analysis, lesion mapping as well as voxel-based lesion-symptom mapping (VLSM). Using diffusion-weighted imaging the microstructure of the cortico-spinal tract (CST) was related to the status of CP by measuring DTI parameters. Whereas children with lesions sparing the primary motor system did not develop CP, CP was always present when extensive lesions damaged at least two brain structures involving the motor system. The VLSM approach provided a statistical map that confirmed the cortical lesions in the primary motor system and revealed that CP was highly correlated with lesions in close proximity to the CST. In children with CP, diffusion parameters indicated microstructural changes in the CST at the level of internal capsule and the centrum semiovale. White matter damage of the CST in centrum semiovale was a highly reproducible marker of CP. This is the first description of the implication of this latter region in motor impairment after NAIS. In conclusion, CP in childhood was closely linked to the location of the infarct in the motor system.
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Affiliation(s)
- Mickael Dinomais
- LUNAM, Université d'Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) - EA7315, F-49000, Angers, France.,LUNAM, CHU Angers, Université d'Angers, Département de Médecine Physique et de Réadaptation, F- 49933, Angers, France
| | - Lucie Hertz-Pannier
- UNIACT, Neurospin, I2BM, DSV, CEA-Saclay, and INSERM U1129 Paris, Université Paris Descartes, Sorbonne Paris Cité, CEA, F-91191, Gif sur Yvette, France
| | - Samuel Groeschel
- Experimental Pediatric Neuroimaging, Department of Pediatric Neurology & Developmental Medicine, University Children's Hospital Tübingen, Germany
| | - Stéphane Chabrier
- CHU Saint-Étienne, Centre national de référence de l'AVC de l'enfant and Inserm CIC1408, F-42055, Saint-Étienne, France.,Université de Saint-x000C9;tienne, Groupe de recherche sur la thrombose - EA3065, F-42023, Saint-Étienne, France
| | - Matthieu Delion
- LUNAM, CHU Angers, Université d'Angers, Département de Neurochirurgie, F-49933, Angers, France.,LUNAM, Université d'Angers, Laboratoire d'Anatomie, Faculté de Médecine F-49045, Angers, France
| | - Béatrice Husson
- Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, Service d'Imagerie Pédiatrique and Centre national de référence de l'AVC de l'enfant, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department and French Center for Pediatric Stroke, University Hospital Necker-Enfants Malades, AP-HP Assistance Publique-Hôpitaux de Paris, F-75743, Paris, France
| | - Cyrille Renaud
- CHU Saint-Étienne, Centre national de référence de l'AVC de l'enfant and Inserm CIC1408, F-42055, Saint-Étienne, France
| | - Sylvie Nguyen The Tich
- LUNAM, Université d'Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) - EA7315, F-49000, Angers, France.,LUNAM, CHU Angers, Université d'Angers, Département de Neuropédiatrie, F-49933, Angers, France
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42
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Becker JS. A Primer for Nurses on Perinatal/Neonatal Stroke. Nurs Womens Health 2015; 19:350-356. [PMID: 26264800 DOI: 10.1111/1751-486x.12221] [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] [Indexed: 06/04/2023]
Abstract
Perinatal or neonatal stroke is not uncommon, but diagnosis is often missed. Perinatal nurses are often the first health professionals in the position to observe the most typical symptom of stroke in a newborn, which is focal seizure. Etiology, symptoms and outcomes are reviewed and discussed through the context of the author's personal story.
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43
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Hart AR, Sharma R, Rittey CD, Mordekar SR. Neonatal hypertonia - a diagnostic challenge. Dev Med Child Neurol 2015; 57:600-610. [PMID: 25495611 DOI: 10.1111/dmcn.12658] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 01/31/2023]
Abstract
In comparison to hypotonia, hypertonia is less commonly expressed in the neonatal period. The scientific literature on the causes of neonatal hypertonia is scant, with no suggested diagnostic algorithm easily available to clinicians. Aetiologies include conditions affecting the central nervous system and spine, and rare peripheral neuromuscular disorders leading to hypertonia. Aetiology onset may be antepartum, peripartum with either transient hypertonia or persistent hypertonia which may appear later, or from a postnatal event/disease. This review discusses neonatal hypertonia and a diagnostic approach to neonatal hypertonia is suggested.
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Affiliation(s)
- Anthony R Hart
- Department of Paediatric Neurology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Ruchi Sharma
- Department of Paediatric Neurodisability, Sheffield Children's Hospital NHS Foundation Trust, Ryegate Children's Centre, Sheffield, UK
| | - Christopher D Rittey
- Department of Paediatric Neurology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Santosh R Mordekar
- Department of Paediatric Neurology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
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44
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Okanishi T, Yamamoto H, Hosokawa T, Ando N, Nagayama Y, Hashimoto Y, Maihara T, Goto T, Kubota T, Kawaguchi C, Yoshida H, Sugiura K, Itomi S, Ohno K, Takanashi JI, Hayakawa M, Otsubo H, Okumura A. Diffusion-weighted MRI for early diagnosis of neonatal herpes simplex encephalitis. Brain Dev 2015; 37:423-31. [PMID: 25149136 DOI: 10.1016/j.braindev.2014.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 10/24/2022]
Abstract
AIM To determine the early changes and evolutions of brain diffusion-weighted imaging (DWI), and analyze prognostic factors of the early changes among patients with neonatal herpes simplex encephalitis (NHSE). METHOD We selected patients who developed encephalitis by 28 d after birth; had herpes simplex infection; and who underwent magnetic resonance imaging, including DWI, ⩽7 d of symptom onset. Thirty-two DWI scans between 0 and 28 d after onset in 13 patients and the clinical data were recruited. The distribution, evolution of the lesions, and neurological outcome were analyzed. RESULTS DWI frequently showed multiple cortical lesions in both hemispheres in the early period and both hemispheres on DWI (8/9 scans at ⩽48 h, 7/7 patients). As time from onset increased, the cortical lesions tended to coincide with subcortical white matter lesions beneath the initial cortical lesions (p<0.01). Lesions from the cortex extended to the subcortical white matter in 7 patients. Deep cerebral lesions, involving basal ganglia, internal capsules, thalamus, were also found in 9 patients ⩽7 d of onset. The distributions of deep cerebral lesions (none/unilateral/bilateral) ⩽7 d of onset showed significant correlations with neurological prognoses (gross motor functions: p<0.01; developmental or intellectual quotient scores: p<0.01). INTERPRETATION Cortical lesions were main findings of DWI in NHSE in the early period. Bilateral deep cerebral lesions ⩽7 d were highly indicative of poor motor and cognitive outcomes.
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Affiliation(s)
- Tohru Okanishi
- Department of Child Neurology, Seirei-Hamamatsu General Hospital, Japan; Department of Pediatrics, Nagoya City University Graduate School of Medicine, Japan.
| | - Hiroyuki Yamamoto
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | | | - Naoki Ando
- Department of Pediatrics, Nagoya City University Graduate School of Medicine, Japan
| | - Yoshihisa Nagayama
- Maternal and Perinatal Care Center, Niigata City General Hospital, Japan
| | - Yuji Hashimoto
- Department of Pediatrics, Chiba Kaihin Municipal Hospital, Japan
| | - Toshiro Maihara
- Department of Pediatrics, Hyogo Prefectural Tsukaguchi Hospital, Japan
| | - Tomohide Goto
- Division of Neurology, Tokyo Metropolitan Children's Medical Center, Japan
| | - Tetsuo Kubota
- Department of Pediatrics, Anjo Kosei Hospital, Japan
| | | | - Hiroshi Yoshida
- Department of Pediatrics, Tsuruoka Municipal Shonai Hospital, Japan
| | | | - Seiko Itomi
- Department of Pediatrics, Japanese Red Cross Nagoya Daiichi Hospital, Japan
| | - Koyo Ohno
- Department of Pediatrics, Tottori Prefectural Central Hospital, Japan
| | | | - Masahiro Hayakawa
- Maternity and Perinatal Care Center, Nagoya University Hospital, Japan
| | - Hiroshi Otsubo
- Department of Neurophysiology, Division of Neurology, The Hospital for Sick Children, Canada
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45
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Weeke LC, Groenendaal F, Toet MC, Benders MJNL, Nievelstein RAJ, van Rooij LGM, de Vries LS. The aetiology of neonatal seizures and the diagnostic contribution of neonatal cerebral magnetic resonance imaging. Dev Med Child Neurol 2015; 57:248-56. [PMID: 25385195 DOI: 10.1111/dmcn.12629] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2014] [Indexed: 12/26/2022]
Abstract
AIM The aim of this study was to delineate aetiologies and explore the diagnostic value of cerebral magnetic resonance imaging (MRI) in addition to cranial ultrasonography (cUS) in infants presenting with neonatal seizures. METHOD This retrospective cohort study comprised infants (gestational age 35.0-42.6wks) with seizures, confirmed by either continuous amplitude-integrated electroencephalography (aEEG) or standard EEG and admitted during a 14-year period to a level three neonatal intensive care unit (n=378; 216 males, 162 females; mean [SD] birthweight 3334g [594]). All infants underwent cUS and MRI (MRI on median of 5 days after birth, range 0-58d) within the first admission period. RESULTS An underlying aetiology was identified in 354 infants (93.7%). The most common aetiologies identified were hypoxic-ischaemic encephalopathy (46%), intracranial haemorrhage (12.2%), and perinatal arterial ischaemic stroke (10.6%). When comparing MRI with cUS in these 354 infants MRI showed new findings which did not become apparent on cUS, contributing to a diagnosis in 42 (11.9%) infants and providing additional information to cUS, contributing to a diagnosis in 141 (39.8%). cUS alone would have allowed a diagnosis in only 37.9% of infants (134/354). INTERPRETATION Cerebral MRI contributed to making a diagnosis in the majority of infants. In 11.9% of infants the diagnosis would have been missed if only cUS were used and cerebral MRI added significantly to the information obtained in 39.8% of infants. These data suggest that cerebral MRI should be performed in all newborn infants presenting with EEG- or aEEG-confirmed seizures.
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Affiliation(s)
- Lauren C Weeke
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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46
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Stojanović V, Barišić N, Milanović B, Doronjski A. Acute kidney injury in preterm infants admitted to a neonatal intensive care unit. Pediatr Nephrol 2014; 29:2213-20. [PMID: 24839217 DOI: 10.1007/s00467-014-2837-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 03/27/2014] [Accepted: 04/22/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND The factors that contribute to the development of acute kidney injury (AKI) and treatment outcome among prematurely born neonates are not clearly understood. METHODS This retrospective study included 150 prematurely born neonates. AKI was defined as an increase of serum creatinine levels ≥0.3 mg/dl compared to basal values. RESULTS The majority of neonates with AKI (94.8 %) had a body weight <1,500 g. Logistic regression analysis showed that the Apgar score in the 5th minute <5, serum lactate levels >5 on the first day of life, core body temperature <36 ºC on the first day of life, occurrence of sepsis, intracranial hemorrhage, necrotizing enterocolitis, patent ductus arteriosus, as well as a treatment with vancomycin or dopamine were independent risk factors for the development of AKI. After the groups of neonates with and without AKI were adjusted, the calculated risk ratio for a negative outcome of treatment (death) was 2.215 (CI 1.27-3.86) for neonates with AKI. Neonates with AKI had higher serum sodium levels in the third and fourth days of life. CONCLUSIONS AKI is associated with high mortality in preterm neonates. It is very important to identify, as quickly as possible, all infants who are at high risk of developing AKI.
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Affiliation(s)
- Vesna Stojanović
- Intensive Care Unit, Institute for Child and Youth Health Care of Vojvodina, Medical Faculty, University of Novi Sad, Hajduk Veljkova 10, Novi Sad, 21000, Serbia,
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47
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Osmond E, Billetop A, Jary S, Likeman M, Thoresen M, Luyt K. Neonatal seizures: magnetic resonance imaging adds value in the diagnosis and prediction of neurodisability. Acta Paediatr 2014; 103:820-6. [PMID: 24494791 DOI: 10.1111/apa.12583] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/12/2013] [Accepted: 01/28/2014] [Indexed: 01/14/2023]
Abstract
AIM To determine the aetiological associations, neurological sequelae and role of magnetic resonance imaging (MRI) in term newborn infants with seizures. METHODS Cohort study of infants ≥37 weeks' gestation delivered in a tertiary level centre, prospectively identified and followed longitudinally for 18-24 months. RESULTS An underlying aetiology was found in 95% of the 77 infants identified with seizures (3.0/1000 live births). The most common diagnosis was hypoxic-ischaemic encephalopathy (HIE) (65%), followed by neonatal stroke (12%). Nine infants died, 28 of the 68 survivors developed neurodevelopmental impairment (NDI), and 15 had recurrent seizures in the first 2 years, with both outcomes more likely in those with a diagnosis other than HIE. Abnormal MRI findings were found in 45 of the 70 infants imaged. The absence of major cerebral lesions was highly predictive of a normal neurological outcome. CONCLUSION We report the first cohort of term infants with seizures fully investigated by MRI. The universal use of MRI enabled a cause to be identified in 95% of cases. The probability of having NDI or recurrence of seizures was extremely low with absence of major cerebral lesions on MRI. This study demonstrates the added value of MRI for diagnosis of aetiology and the prediction of neurological outcome.
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Affiliation(s)
| | - Amiel Billetop
- Neonatal Intensive Care unit; St Michael's Hospital; Bristol UK
| | - Sally Jary
- Neonatal Neuroscience; School of Clinical Sciences; University of Bristol; Neonatal Intensive Care Unit; St Michael's Hospital; Bristol UK
| | - Marcus Likeman
- Paediatric Neuroradiology; Bristol Royal Hospital for Children; University Hospitals Bristol NHS Trust; Bristol UK
| | - Marianne Thoresen
- Neonatal Intensive Care unit; St Michael's Hospital; Bristol UK
- Neonatal Neuroscience; School of Clinical Sciences; University of Bristol; Neonatal Intensive Care Unit; St Michael's Hospital; Bristol UK
| | - Karen Luyt
- Neonatal Intensive Care unit; St Michael's Hospital; Bristol UK
- Neonatal Neuroscience; School of Clinical Sciences; University of Bristol; Neonatal Intensive Care Unit; St Michael's Hospital; Bristol UK
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48
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Low E, Mathieson SR, Stevenson NJ, Livingstone V, Ryan CA, Bogue CO, Rennie JM, Boylan GB. Early postnatal EEG features of perinatal arterial ischaemic stroke with seizures. PLoS One 2014; 9:e100973. [PMID: 25051161 PMCID: PMC4106759 DOI: 10.1371/journal.pone.0100973] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 06/01/2014] [Indexed: 11/18/2022] Open
Abstract
Background Stroke is the second most common cause of seizures in term neonates and is associated with abnormal long-term neurodevelopmental outcome in some cases. Objective To aid diagnosis earlier in the postnatal period, our aim was to describe the characteristic EEG patterns in term neonates with perinatal arterial ischaemic stroke (PAIS) seizures. Design Retrospective observational study. Patients Neonates >37 weeks born between 2003 and 2011 in two hospitals. Method Continuous multichannel video-EEG was used to analyze the background patterns and characteristics of seizures. Each EEG was assessed for continuity, symmetry, characteristic features and sleep cycling; morphology of electrographic seizures was also examined. Each seizure was categorized as electrographic-only or electroclinical; the percentage of seizure events for each seizure type was also summarized. Results Nine neonates with PAIS seizures and EEG monitoring were identified. While EEG continuity was present in all cases, the background pattern showed suppression over the infarcted side; this was quite marked (>50% amplitude reduction) when the lesion was large. Characteristic unilateral bursts of theta activity with sharp or spike waves intermixed were seen in all cases. Sleep cycling was generally present but was more disturbed over the infarcted side. Seizures demonstrated a characteristic pattern; focal sharp waves/spike-polyspikes were seen at frequency of 1–2 Hz and phase reversal over the central region was common. Electrographic-only seizure events were more frequent compared to electroclinical seizure events (78 vs 22%). Conclusions Focal electrographic and electroclinical seizures with ipsilateral suppression of the background activity and focal sharp waves are strong indicators of PAIS. Approximately 80% of seizure events were the result of clinically unsuspected seizures in neonates with PAIS. Prolonged and continuous multichannel video-EEG monitoring is advocated for adequate seizure surveillance.
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Affiliation(s)
- Evonne Low
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Sean R. Mathieson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London Hospital, London, United Kingdom
| | - Nathan J. Stevenson
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Vicki Livingstone
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - C. Anthony Ryan
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Conor O. Bogue
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Janet M. Rennie
- Elizabeth Garrett Anderson Institute for Women's Health, University College London Hospital, London, United Kingdom
| | - Geraldine B. Boylan
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- * E-mail:
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49
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Kharoshankaya L, Filan PM, Bogue CO, Murray DM, Boylan GB. Global suppression of electrocortical activity in unilateral perinatal thalamic stroke. Dev Med Child Neurol 2014; 56:695-8. [PMID: 24410068 PMCID: PMC4190684 DOI: 10.1111/dmcn.12365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 12/03/2022]
Abstract
We present an unusual case of persistent generalized electroencephalography (EEG) suppression and right-sided clonic seizures in a male infant born at 40(+2) weeks' gestation, birthweight 3240g, with an isolated unilateral thalamic stroke. The EEG at 13 hours after birth showed a generalized very low amplitude background pattern, which progressed to frequent electrographic seizures over the left hemisphere. The interictal background EEG pattern remained grossly abnormal over the next 48 hours, showing very low background amplitudes (<10μV). Magnetic resonance imaging revealed an isolated acute left-sided thalamic infarction. This is the first description of severe global EEG suppression caused by an isolated unilateral thalamic stroke and supports the role of the thalamus as the control centre for cortical electrical activity.
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Affiliation(s)
- Liudmila Kharoshankaya
- Department of Paediatrics and Child Health, University College CorkCork, Ireland,Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity HospitalCork, Ireland,Correspondence to Liudmila Kharoshankaya, Neonatal Brain Research Group, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland. E-mail:
| | - Peter M Filan
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity HospitalCork, Ireland,Department of Neonatology, Cork University Maternity HospitalCork, Ireland
| | - Conor O Bogue
- Department of Radiology, Cork University HospitalCork, Ireland
| | - Deirdre M Murray
- Department of Paediatrics and Child Health, University College CorkCork, Ireland,Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity HospitalCork, Ireland
| | - Geraldine B Boylan
- Department of Paediatrics and Child Health, University College CorkCork, Ireland,Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity HospitalCork, Ireland
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50
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Sannia A, Natalizia AR, Parodi A, Malova M, Fumagalli M, Rossi A, Ramenghi LA. Different gestational ages and changing vulnerability of the premature brain. J Matern Fetal Neonatal Med 2013; 28 Suppl 1:2268-72. [PMID: 23968292 DOI: 10.3109/14767058.2013.796166] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In recent decades, there has been a general increase in survival rates of preterm and low birth weight infants, but this overall decrease in perinatal mortality has not been accompanied by a decrease in long-term physical and mental disability. In order to reduce the long-term sequelae of prematurity and to establish preventive measures, it is important to identify risk factors since the main determinant of specific vulnerability to different types of lesions is gestational age. The regional tissue vulnerability at a given gestational age is probably determined by the local metabolic requirements together with specific cell characteristics and their level of maturation. In this article, we discuss the most common neonatal cerebral lesions (cerebellar haemorrhage, germinal matrix intraventricular haemorrhage, periventricular leukomalacia, arterial ischaemic stroke, cerebral vein sinus thrombosis and hypoxic-ischaemic encephalopathy) related to the gestational age-dependent vulnerability of the premature brain.
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Affiliation(s)
- Andrea Sannia
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Anna R Natalizia
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Alessandro Parodi
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Mariya Malova
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Monica Fumagalli
- b NICU, Department of Clinical Sciences and Community Health , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano , Milan , Italy , and
| | - Andrea Rossi
- c Pediatric Neuroradiology Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Luca A Ramenghi
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
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