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Patterns of Brain Injury in Perinatal Arterial Ischemic Stroke and the Development of Infantile Spasms

Ratika Srivastava1,2, Oriana E F Shaw2, Edward Armstrong2

  • 1Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, 25484University of Alberta, Edmonton, Alberta, Canada.

Journal of Child Neurology
|February 5, 2021
PubMed

Insights

Perinatal arterial ischemic stroke (PAIS) linked to infantile spasms (IS) often involves deep brain structures. Identifying these injury patterns can help predict which infants with PAIS are at higher risk for IS.

Area of Science:

  • Neurology
  • Pediatric Neurology
  • Neuroimaging

Background:

  • Perinatal arterial ischemic stroke (PAIS) is a significant cause of neurological impairment in infants.
  • Approximately 10% of infantile spasms (IS) cases are associated with PAIS.
  • Understanding the relationship between stroke patterns and IS is crucial for early diagnosis and intervention.

Purpose of the Study:

  • To identify specific patterns of brain injury in perinatal arterial ischemic stroke (PAIS) that predispose infants to developing infantile spasms (IS).
  • To compare the characteristics of brain injury in PAIS patients with and without IS.

Main Methods:

  • Retrospective analysis of 64 term-born patients with perinatal arterial ischemic stroke (PAIS) confirmed by MRI.
  • Assessment of stroke injury patterns using the modified pediatric ASPECTS (modASPECTS) scoring system.
  • Comparison of injury patterns between patients who developed infantile spasms (PAIS-IS) and those who remained seizure-free (PAIS-only).

Main Results:

  • Patients who developed infantile spasms (PAIS-IS) had significantly higher modASPECTS scores compared to the seizure-free group (PAIS-only).
  • A higher proportion of PAIS-IS patients (67%) exhibited injury to deep cerebral structures compared to the PAIS-only group (25%).
  • Infarct size was significantly associated with the development of infantile spasms.

Conclusions:

  • The findings suggest that injury to deep cerebral structures in perinatal arterial ischemic stroke is associated with an increased risk of developing infantile spasms.
  • This research aids in identifying infants with PAIS who are at risk for infantile spasms, potentially enabling earlier diagnosis and management.
  • The study supports the role of deep cerebral structures in the pathogenesis of infantile spasms.
Abstract

Keywords:
West syndromeepilepsyinfantile spasmsischemic strokemagnetic resonance imaging (MRI)perinatal strokeseizure

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