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New insights in perinatal arterial ischemic stroke by assessing brain perfusion
Pia Wintermark1, Simon K Warfield
1Division of Newborn Medicine, Montreal Children's Hospital, McGill University, 2300 rue Tupper, C-920, Montreal, QC, H3H 1P3, Canada, Pia.Wintermark@bluemail.ch.
Insights
Arterial spin labeling (ASL) MRI effectively assesses brain perfusion in newborns with perinatal arterial ischemic stroke (AIS). This technique reveals abnormal cerebral blood flow patterns, aiding in understanding stroke mechanisms and guiding potential treatments.
Area of Science:
- Neonatal Neurology
- Pediatric Radiology
- Neuroimaging
Background:
- Perinatal arterial ischemic stroke (AIS) significantly impacts long-term child health.
- Understanding neonatal stroke mechanisms is crucial for developing effective interventions.
Purpose of the Study:
- To evaluate brain perfusion in newborns diagnosed with AIS within the first month of life.
- To assess the utility of arterial spin labeling (ASL) perfusion imaging in this population.
Main Methods:
- Utilized magnetic resonance imaging (MRI) with ASL perfusion sequences.
- Studied four term newborns diagnosed with AIS, focusing on middle cerebral artery territories.
- Analyzed cerebral blood flow (CBF) patterns in stroke-affected brain regions.
Main Results:
- Demonstrated the feasibility of ASL MRI in term newborns with AIS.
- Observed abnormal brain perfusion in all AIS patients.
- Reported varied CBF changes: increased in one patient, decreased centrally with peripheral increase in three others.
Conclusions:
- ASL MRI is a feasible and valuable tool for assessing brain hemodynamics in neonatal AIS.
- ASL provides crucial information on perfusion abnormalities in stroke areas.
- Further research is needed to determine ASL's role in identifying salvageable tissue and guiding treatment.
Abstract:
Perinatal arterial ischemic stroke (AIS) is an important cause of long-term morbidity in children. Thus, there is an urgent need to better understand the mechanisms of stroke in newborns in order to develop effective treatment and prevention strategies. The purpose of this study was to assess brain perfusion within the first month of life in newborns with AIS. In this study, magnetic resonance imaging (MRI) and perfusion imaging by arterial spin labeling (ASL) were used to assess brain perfusion in four term newborns with AIS. One patient had a stroke within the territory of the right middle cerebral artery (MCA); the other three patients had a stroke within the territory of the left MCA. None of them displayed any hemorrhagic component. All four patients demonstrated abnormal brain perfusion in the stroke area. Cerebral blood flow (CBF) within the stroke area was increased in patient # 1. In all other three patients, CBF was decreased within the stroke center and increased in the periphery of the stroke area. These results show the feasibility of the ASL sequence in newborns with AIS and support its addition to the current MRI protocol used in these newborns as it provides useful information on brain hemodynamics. Its value for identifying salvageable tissue in newborns needs to be further assessed, as well as its potential role in stroke follow-up and for tissue-specific treatment screening.
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