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The Hypoxic Ischemic Encephalopathy Model of Perinatal Ischemia
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Neurodevelopment After Perinatal Arterial Ischemic Stroke.

Nienke Wagenaar1, Miriam Martinez-Biarge2, Niek E van der Aa1

  • 1Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and.

Pediatrics
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PubMed
Summary
This summary is machine-generated.

Perinatal arterial ischemic stroke (PAIS) outcomes vary by location and tissue affected. Main branch middle cerebral artery (MCA) strokes predict poor outcomes, while other PAIS subtypes show more favorable results.

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Area of Science:

  • Neurology
  • Pediatrics
  • Neuroimaging

Background:

  • Perinatal arterial ischemic stroke (PAIS) is a significant cause of childhood cerebral palsy and other neurological deficits.
  • Existing outcome studies often overlook the specific site and extent of brain tissue affected by PAIS, particularly middle cerebral artery (MCA) strokes.

Purpose of the Study:

  • To investigate and report neurodevelopmental outcomes in infants based on different subtypes of perinatal arterial ischemic stroke (PAIS).
  • To determine the impact of stroke location and specific tissue involvement on long-term outcomes in affected children.

Main Methods:

  • A cohort of 188 term infants diagnosed with PAIS between 1990 and 2015 from two centers were included.
  • Neonatal MRI scans were re-evaluated to classify stroke territory and affected tissues.
  • Neurodevelopmental outcomes, including cerebral palsy, cognitive deficits, and epilepsy, were assessed at a median follow-up of 41.7 months.

Main Results:

  • Middle cerebral artery (MCA) territory strokes were most common (90%).
  • Infants with main branch MCA stroke experienced 100% adverse outcomes.
  • Other PAIS subtypes had adverse outcomes in 29%–57% of cases, with corticospinal tract and basal ganglia involvement being key predictors.

Conclusions:

  • Neurodevelopmental outcomes in PAIS are significantly influenced by the stroke's site and the specific brain tissues involved.
  • While main branch MCA strokes are associated with universally adverse outcomes, other PAIS subtypes demonstrate a higher likelihood of favorable outcomes (43%–71%).