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Long term motor function after neonatal stroke: Lesion localization above all.

Mickael Dinomais1,2, Lucie Hertz-Pannier3, Samuel Groeschel4

  • 1LUNAM, Université d'Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) - EA7315, F-49000, Angers, France.

Human Brain Mapping
|October 30, 2015
PubMed
Summary

Neonatal arterial ischemic stroke (NAIS) can lead to variable motor outcomes. Lesion location in the motor system, particularly near the cortico-spinal tract (CST), strongly predicts cerebral palsy (CP) development in children with NAIS.

Keywords:
brain lesioncerebral palsymorphometrymotor deficitneonatal stroke

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Area of Science:

  • Neurology
  • Pediatric Neurology
  • Neuroimaging

Background:

  • Motor outcome in children following neonatal arterial ischemic stroke (NAIS) is highly variable.
  • Understanding the relationship between brain lesion characteristics and motor deficits is crucial for predicting outcomes.

Purpose of the Study:

  • To analyze the association between brain lesion characteristics on MRI and motor function in children with unilateral NAIS.
  • To identify specific lesion locations and microstructural changes in the cortico-spinal tract (CST) associated with cerebral palsy (CP) after NAIS.

Main Methods:

  • Investigated 38 children with unilateral NAIS at age seven using 3T MRI (3D T1- and 3D FLAIR-weighted images).
  • Employed lesion mapping, voxel-based lesion-symptom mapping (VLSM), and diffusion tensor imaging (DTI) to analyze lesion characteristics and CST microstructure.
  • Compared lesion features between children with and without cerebral palsy (CP).

Main Results:

  • Children with lesions sparing the primary motor system did not develop CP.
  • CP was consistently present when extensive lesions damaged at least two motor system structures.
  • VLSM confirmed cortical lesions in the primary motor system and highlighted proximity to the CST as critical.
  • Microstructural changes in the CST (internal capsule, centrum semiovale) were evident in children with CP.
  • White matter damage in the centrum semiovale's CST was a reproducible marker for CP.

Conclusions:

  • Cerebral palsy in childhood following NAIS is strongly linked to the infarct's location within the motor system.
  • Lesions near the CST and microstructural CST damage are key indicators of motor impairment after NAIS.
  • Damage to the CST in the centrum semiovale is a significant, reproducible marker for CP in this population.