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Cortical Sparing in Preterm Ischemic Arterial Stroke.

Niek E van der Aa1, Manon J N L Benders2, Peter G Nikkels2

  • 1From the Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands (N.E.v.d.A., M.J.N.L.B., F.G., L.S.d.V.); and Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands (P.G.N.). n.vanderaa@umcutrecht.nl.

Stroke
|January 14, 2016
PubMed
Summary

Perinatal arterial ischemic stroke in preterm infants can spare the cortex while damaging white matter. This pattern differs from full-term infants and impacts neurological outcomes similarly.

Keywords:
magnetic resonance imagingmiddle cerebral arteryperinatal arterial ischemic strokepreterm birthstroke

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Area of Science:

  • Neuroscience
  • Pediatric Neurology
  • Neonatal Stroke

Background:

  • Perinatal arterial ischemic stroke (AIS) in the middle cerebral artery (MCA) territory typically causes cortical gray matter and subcortical white matter loss.
  • A distinct pattern of residual injury has been observed in preterm infants following MCA stroke, characterized by cortical sparing.

Purpose of the Study:

  • To describe a unique pattern of residual injury after MCA stroke in preterm infants where the cortex is spared.
  • To investigate the correlation between this injury pattern and neurodevelopmental outcomes.

Main Methods:

  • Retrospective review of magnetic resonance imaging (MRI) scans from 40 infants (12 preterm, 28 full-term) with large MCA strokes.
  • Correlation of imaging findings with clinical outcomes.

Main Results:

  • Complete cortical sparing with underlying white matter cavitation occurred in 3 preterm infants; 4 others showed partial sparing.
  • One full-term infant exhibited partial cortical sparing; others had none.
  • Hemiplegia developed in 86% of infants, and 30% had a developmental quotient below 85, irrespective of cortical injury pattern.

Conclusions:

  • The pattern of cortical injury following MCA stroke varies with gestational age, potentially due to vascular system maturation.
  • Neurodevelopmental outcomes did not significantly differ across the observed patterns of cortical injury.