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Presumed perinatal ischemic stroke: vascular classification predicts outcomes

Adam Kirton1, Gabrielle Deveber, Ann-Marie Pontigon

  • 1Division of Neurology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada. adam.kirton@calgaryhealthregion.ca

Annals of Neurology
|February 29, 2008
PubMed

Insights

Presumed perinatal ischemic stroke (PPIS) can result from arterial strokes or venous periventricular infarction (PVI). Identifying PPIS patterns aids in predicting long-term neurological outcomes and guiding treatment.

Area of Science:

  • Neurology
  • Pediatric Medicine
  • Neuroimaging

Background:

  • Perinatal stroke is a significant cause of childhood neurological disability.
  • Presumed perinatal ischemic stroke (PPIS) describes chronic focal brain infarction identified postnatally.
  • Recent evidence suggests periventricular venous infarction (PVI) in preterm infants may also manifest as PPIS.

Purpose of the Study:

  • To define arterial and PVI PPIS syndromes.
  • To determine the neurological outcomes associated with each PPIS type.
  • To analyze the largest published cohort of PPIS cases.

Main Methods:

  • Systematic neuroradiological scoring of a consecutive PPIS cohort (1992-2006).
  • Defined criteria for PVI, including unilateral injury patterns and specific imaging findings.
  • Validated arterial and PVI classifications and correlated them with neurological outcomes using the Pediatric Stroke Outcome Measure.

Main Results:

  • Of 59 PPIS cases, 94% involved potential middle cerebral artery territories.
  • Arterial infarction was most common (35%), followed by venous PVI (22%), which accounted for 75% of subcortical injuries.
  • Basal ganglia involvement predicted motor outcomes (hemiparesis, spasticity), while cortical involvement predicted nonmotor outcomes (cognitive, visual, epilepsy).

Conclusions:

  • Recognizable PPIS patterns effectively predict long-term neurological morbidity.
  • PVI is an underrecognized cause of PPIS and congenital hemiplegia.
  • Classification of PPIS subtypes can guide surveillance, therapy, and counseling for affected children.
Abstract

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