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Updated: Aug 16, 2025
Transient Middle Cerebral Artery Occlusion Model of Neonatal Stroke in P10 Rats
Published on: April 21, 2017
Early predictors of neurodevelopment after perinatal arterial ischemic stroke: a systematic review and meta-analysis
Lisanne M Baak1, Niek E van der Aa1, Annemijn A E Verhagen1
1Department of Neonatology, University Medical Center Utrecht Brain Center and Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands.
Insights
Early MRI and motor assessments best predict cerebral palsy in infants with perinatal arterial ischemic stroke (PAIS). Further research is needed for predicting non-motor outcomes.
Area of Science:
- Neurology
- Pediatrics
- Developmental Neuroscience
Background:
- Perinatal arterial ischemic stroke (PAIS) can lead to lifelong neurodevelopmental challenges.
- Identifying early predictors is crucial for timely intervention and management.
Conclusions:
- Corticospinal tract assessment on MRI and motor assessments are key for predicting cerebral palsy post-PAIS.
- Bedside techniques may enhance prediction of cognitive outcomes.
- Future research should prioritize developing predictors for non-motor outcomes in PAIS.
Background And Aims:
Perinatal arterial ischemic stroke (PAIS) often has lifelong neurodevelopmental consequences. We aimed to review early predictors (<4 months of age) of long-term outcome.
Methods:
We carried out a systematic literature search (PubMed and Embase), and included articles describing term-born infants with PAIS that underwent a diagnostic procedure within four months of age, and had any reported outcome parameter ≥12 months of age. Two independent reviewers included studies and performed risk of bias analysis.
Results:
We included 41 articles reporting on 1395 infants, whereof 1255 (90%) infants underwent follow-up at a median of 4 years. A meta-analysis was performed for the development of cerebral palsy (n = 23 studies); the best predictor was the qualitative or quantitative assessment of the corticospinal tracts on MRI, followed by standardized motor assessments. For long-term cognitive functioning, bedside techniques including (a)EEG and NIRS might be valuable. Injury to the optic radiation on DTI correctly predicted visual field defects. No predictors could be identified for behavior, language, and post-neonatal epilepsy.
Conclusion:
Corticospinal tract assessment on MRI and standardized motor assessments are best to predict cerebral palsy after PAIS. Future research should be focused on improving outcome prediction for non-motor outcomes.
Impact:
We present a systematic review of early predictors for various long-term outcome categories after perinatal arterial ischemic stroke (PAIS), including a meta-analysis for the outcome unilateral spastic cerebral palsy. Corticospinal tract assessment on MRI and standardized motor assessments are best to predict cerebral palsy after PAIS, while bedside techniques such as (a)EEG and NIRS might improve cognitive outcome prediction. Future research should be focused on improving outcome prediction for non-motor outcomes.
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