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Frequency and Distribution of Perinatal Arterial Ischemic Stroke in a Cohort of Patients With Cerebral Palsy Using
Mohammad Jalloul1, Shyam Sunder B Venkatakrishna1, Cesar Augusto P Alves1
1Department of Radiology, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA.
Insights
Perinatal arterial ischemic stroke (PAIS) is rare in children with cerebral palsy (CP), occurring in 0.9% of cases. When present, PAIS often affects the left middle cerebral artery and can co-occur with hypoxic-ischemic injury (HII).
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder.
- Hypoxic-ischemic injury (HII) is a significant cause of brain damage in newborns.
- Perinatal arterial ischemic stroke (PAIS) is a less understood cause of neurological deficits in children.
Purpose of the Study:
- To investigate the prevalence and MRI features of PAIS in children diagnosed with CP and suspected term HII.
- To determine the relationship between PAIS and HII in this population.
Main Methods:
- Retrospective review of brain MRI scans.
- Analysis of data from children with CP and suspected term HII in South Africa.
Main Results:
- PAIS was identified in 0.9% (15/1620) of children with CP.
- The left middle cerebral artery was the most common infarct location.
- 47% of PAIS cases had concurrent HII (predominantly basal-ganglia-thalamus and watershed patterns).
- 88% of isolated PAIS cases showed network injuries, particularly in the internal capsule, cerebral peduncles, thalami, and corpus callosum.
Conclusions:
- PAIS is an uncommon finding in children with CP.
- The left middle cerebral artery is the most frequent site for PAIS.
- PAIS can occur independently or concurrently with HII, presenting diverse MRI patterns.
Purpose:
This study examined the occurrence and MRI characteristics of perinatal arterial ischemic stroke (PAIS) in children with cerebral palsy (CP) and suspected term hypoxic-ischemic injury (HII).
Methods:
A retrospective review of brain MRI scans was conducted on children with CP and suspected term HII in South Africa.
Results:
Out of 1620 children with CP included in the study, 15 (0.9%) had PAIS. The most common site of infarct was the left middle cerebral artery. The majority of infarcts were unilateral, and 67% of cases exhibited cystic changes. Among children with PAIS, 47% exhibited concurrent HII, with the predominant patterns being basal-ganglia-thalamus (BGT) and watershed (WS). In cases of isolated PAIS (53%), network injuries were prevalent in 88% of children, most commonly involving the posterior limbs of the internal capsule, cerebral peduncles, thalami, and corpus callosum.
Conclusions:
The study highlights that PAIS is a relatively rare condition in children with CP, predominantly occurring in the left middle cerebral artery.
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