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Presumed Perinatal Stroke: Risk Factors, Clinical and Radiological Findings
Pilvi Ilves1, Rael Laugesaar2, Dagmar Loorits3
1Radiology Clinic of Tartu University Hospital, Tartu, Estonia Department of Radiology, University of Tartu, Tartu, Estonia pilvi.ilves@kliinikum.ee.
Insights
Late-presenting perinatal strokes in infants are often venous, not arterial. These presumed perinatal strokes frequently originate before birth, with many infants showing no symptoms at birth.
Area of Science:
- Neonatal Neurology
- Pediatric Stroke Research
- Perinatal Medicine
Background:
- Perinatal stroke diagnosis often occurs later in infancy, with unclear reasons for delayed symptom presentation.
- Understanding risk factors and clinical/radiological data is crucial for presumed perinatal stroke cases.
Purpose of the Study:
- To investigate the characteristics and potential origins of presumed perinatal stroke in infants.
- To differentiate between arterial ischemic stroke and periventricular venous infarction in this cohort.
Main Methods:
- Retrospective review of clinical and radiological data from 42 infants in the Estonian Pediatric Stroke Database.
- Analysis of risk factors, delivery details, and neonatal symptoms.
Main Results:
- Periventricular venous infarction (69%) was more common than arterial ischemic stroke (31%) in presumed perinatal stroke cases.
- Most infants (95%) were born at term, and 43% had no identified prenatal risk factors.
- Infants with periventricular venous infarction were more likely to be born vaginally and had fewer neonatal complications compared to those with arterial stroke.
Conclusions:
- Periventricular venous infarction is the predominant type of brain lesion in presumed perinatal stroke.
- The findings suggest a prenatal origin for many cases of presumed perinatal stroke, particularly periventricular venous infarction.
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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