Short-term outcomes after a neonatal arterial ischemic stroke.

PURPOSE: The purpose of this study is to determine the frequency and radiological predictors of recurrent acute symptomatic seizures (RASS) and motor impairment at discharge after a neonatal arterial ischemic stroke (NAIS). METHODS: In a nonconcurrent cohort study, 33 full-term newborns with NAIS confirmed by MRI are admitted into our hospital between January 2003 and December 2012. Stroke size, calculated as stroke volume divided by whole brain volume (WBV), was categorized as > or < 3.3% of WBV. A univariate analysis of categorical variables was performed using Fisher's exact test. A multivariate analysis was performed using logistic regression models including all variables with a p value < 0.1 in the univariate analysis. RESULTS: The median age at NAIS was 2 days (IQR, 1-5.6), 36.4% were girls. The stroke size was > 3.3 of WBV in 48.5% of the cases, and 54.5% showed multifocal lesions. Involvement of the cerebral cortex (54.5%), thalamus (48.5%), posterior limb of the internal capsule (36.4%), basal ganglia (36.4%), and brainstem (28.2%) were found. At discharge, 45.5% of newborns had a motor deficit, and 27.3% had at least two seizures. Multivariate analyses revealed that stroke size > 3.3% of WBV (OR: 8.1, CI: 1.2-53.9) and basal ganglia involvement (OR: 12.8, CI: 1.7-95.4) predicted motor impairment at discharge. Cortical involvement of temporal and frontal lobes (OR: 14, CI: 2.2-88.1; and OR: 9.1, CI: 1.2-72.6) were predictive of RASS. CONCLUSION: Stroke size and location are independent risk factors for adverse short-term neurological outcomes in full-term newborns following a NAIS.

Placental Pathology in Neonatal Stroke: A Retrospective Case-Control Study.

OBJECTIVE: To assess the association of placental abnormalities with neonatal stroke. STUDY DESIGN: This retrospective case-control study at 3 academic medical centers examined placental specimens for 46 children with neonatal arterial or venous ischemic stroke and 99 control children without stroke, using a standard protocol. Between-group comparisons used χ2 and Fisher exact t test. Correlations used Spearman correlation coefficient. RESULTS: Case placentas were more likely than controls to meet criteria for ≥1 of 5 major categories of pathologic abnormality (89% vs 62%; OR, 5.1; 95% CI, 1.9-14.0; P = .0007) and for ≥2 categories (38% vs 8%; OR, 7.3; 95% CI, 2.9-19.0; P < .0001). Fetal vascular malperfusion occurred in 50% of cases and 17% of controls (OR, 4.8; 95% CI, 2.2-10.5; P = .0001). Amniotic fluid inflammation occurred in 46% of cases with arterial ischemic stroke vs 25% of controls (OR, 2.6; 95% CI, 1.1-6.1; P = .037). There was evidence of a "stress response" (meconium plus elevated nucleated red blood cells) in 24% of cases compared with 1% of controls (OR, 31; 95% CI, 3.8-247.0; P < .0001). CONCLUSIONS: Placental abnormality was more common in children with neonatal stroke compared with controls. All placental findings represent subacute-to-chronic intrauterine stressors. Placental thrombotic processes were associated with both arterial and venous stroke. Our findings provide evidence for specific mechanisms that may predispose to acute perinatal stroke. Amniotic fluid inflammation associated with neonatal arterial ischemic stroke deserves further investigation.

Risk Factors for Perinatal Arterial Ischemic Stroke: A Case-Control Study.

INTRODUCTION: Arterial ischemic stroke in newborns is an important cause of neonatal morbidity and mortality. Its pathophysiology and associated risk factors are not yet clearly understood and defined. OBJECTIVE: The aim of this retrospective study was to investigate possible risk factors in diagnosed cases of PAIS (perinatal arterial ischemic stroke). MATERIALS AND METHODS: Case-control study. Clinical data of patients with PAIS diagnosis were analyzed. Two healthy controls were selected for each PAIS case, matched for gestational age. Risk factors were explored using univariable and multivariable analysis. OUTCOME: 40 patients were included in the study, 24 males and 16 females; 52.5% of cases were diagnosed within the first month of birth, and 47.5% were retrospectively diagnosed. The results showed a male predominance (66.7%). The distribution of cerebral ischemic injury was predominantly medial cerebral artery (87.5%) and occurred more commonly in the left cerebral hemisphere (62.5%). Significant risk factors in the univariate analysis (P < 0.05) were primiparity, stillbirth, neonatal sepsis, asphyxia, twin pregnancy, placenta abruption, emergency cesarean section, Apgar score ≤7 after 5 min, breech presentation, and hyperbilirubinemia. In the multivariate analysis, primiparity (OR 11.74; CI 3.28-42.02), emergency cesarean section (OR 13.79; CI 3.51-54.13), birth asphyxia (OR 40.55; CI 3.08-532.94) and Apgar score ≤7 after 5 min (OR 13.75; CI 1.03-364.03) were significantly associated factors with PAIS. Only five (16.6%) patients had an abnormal thrombophilia study. CONCLUSION: Risk factors of primiparity, emergency cesarean section, birth asphyxia, and Apgar score ≤7 after 5 min were significantly associated with perinatal stroke. More studies with a larger number of patients and with prolonged follow up are required to establish more clearly the associated risk factors involved in this pathology.