Long-Term Outcome After Bilateral Perinatal Arterial Ischemic Stroke

Area of Science:

• Neurology
• Pediatrics
• Neonatal care

Background:

• Perinatal arterial ischemic stroke (PAIS) affects newborns.
• Bilateral large vessel involvement is a rare but severe form of PAIS.

Purpose of the Study:

• To characterize the phenotype and outcomes of children with bilateral, large vessel perinatal arterial ischemic stroke.
• To assess the long-term sequelae and epilepsy risk in this specific pediatric stroke population.

Main Methods:

• Retrospective analysis of a population-based cohort (Alberta Perinatal Stroke Project).
• Inclusion criteria: stroke in major cerebral artery territories in both hemispheres on MRI.
• Outcomes assessed using standardized measures: Pediatric Stroke Outcome Measure, Gross Motor Function Classification System, and epilepsy frequency.

Main Results:

• Eight of 174 (5%) children had bilateral large vessel PAIS.
• Mean follow-up was 9.7 years; one mortality.
• All children exhibited significant motor deficits (GMFCS ≥ II) and cognitive impairment (PSOM ≥ 2); 88% had epilepsy.

Conclusions:

• Bilateral large vessel PAIS is associated with a high risk of severe neurodevelopmental impairments.
• Epilepsy appears more prevalent compared to unilateral strokes.
• Prognosis discussions with families should be approached with caution due to the severity of outcomes.