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Published on: April 21, 2017
Perinatal arterial ischemic stroke and periventricular venous infarction in infants with unilateral cerebral palsy
Melissa Vitagliano1, Mary Dunbar2, Sasha Dyck Holzinger3
1Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Insights
Clinical factors like maternal infections and diabetes are linked to perinatal strokes (arterial ischemic stroke and periventricular venous infarction) in infants with unilateral cerebral palsy. Intrapartum factors are associated with AIS, while in utero factors are linked to PVI.
Area of Science:
- Neurology
- Pediatrics
- Obstetrics
Background:
- Unilateral cerebral palsy (CP) in infants can stem from perinatal strokes, including arterial ischemic stroke (AIS) and periventricular venous infarction (PVI).
- Understanding the distinct clinical factors associated with AIS and PVI is crucial for targeted prevention and intervention strategies.
Purpose of the Study:
- To identify and analyze clinical factors associated with perinatal AIS and PVI in infants diagnosed with unilateral CP.
- To differentiate between risk factors for AIS and PVI in the context of unilateral CP.
Main Methods:
- A case-control study utilizing data from the Canadian Cerebral Palsy Registry (CCPR) up to 2019.
- Infants with confirmed unilateral CP were categorized based on expert review of MRI reports identifying AIS or PVI.
- Multivariable regression analyses were performed to determine associations between clinical factors and stroke types.
Main Results:
- Of 662 unilateral CP cases, 299 (45%) had perinatal stroke (169 AIS, 130 PVI).
- Independent risk factors for both AIS and PVI included chorioamnionitis, illicit drug exposure, diabetes, gestational age, and maternal age.
- AIS was uniquely associated with low Apgar scores and prolonged rupture of membranes, while PVI was linked to small for gestational age infants and primigravida status.
Conclusions:
- Clinical factors associated with unilateral CP differ between AIS and PVI.
- Acute intrapartum events are primarily linked to AIS, whereas in utero factors are predominantly associated with PVI.
- Disease-specific analysis of unilateral CP offers insights into its pathophysiology and potential etiological pathways.
Aim:
To explore clinical factors associated with perinatal arterial ischemic stroke (AIS) and periventricular venous infarction (PVI) in infants who develop unilateral cerebral palsy (CP).
Method:
This was a case-control study. Data current to 2019 was extracted from the Canadian Cerebral Palsy Registry (CCPR). Cases were infants born at term with confirmed unilateral CP. Magnetic resonance images were stratified by expert review of reports as definitive perinatal stroke (AIS or PVI). Controls with common data elements were recruited from a population-based study in Alberta. Multivariable regression analyses were performed to estimate associations expressed as odds ratios with 95% confidence intervals.
Results:
Of 2093 cases from the CCPR, 662 had unilateral CP, of whom 299 (45%) had perinatal stroke: AIS 169 (57%) and PVI 130 (43%). Median age at diagnosis for AIS was 11.9 months (interquartile range: 6.2-25.7mo; range 0.17-104.1mo), and 58.6% were male. Median age at diagnosis for PVI was 25.3 months (interquartile range: 14.5-38mo, range 0.7-114.7mo) and 57.7% were male. Independent associations for both AIS and PVI on multivariable analysis were chorioamnionitis, illicit drug exposure, diabetes, gestational age, and maternal age. Variables associated with AIS alone were low Apgar score and prolonged rupture of membranes. Variables associated with PVI alone were small for gestational age and primigravida.
Interpretation:
Controlled analysis of disease-specific unilateral CP may offer unique perspectives on its pathophysiology. Acute intrapartum factors are mainly associated with AIS, while in utero factors are associated with PVI.
