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Evaluation of perinatal arterial ischemic stroke patients: Underlying etiologic factors and long-term prognosis
Çisem Duman Kayar1, Rıdvan Avcı1, Fulya Kürekçi1
1Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Turkey.
Insights
Early EEG and MRI findings are crucial for predicting epilepsy and poor outcomes in perinatal arterial ischemic stroke (PAIS). These insights are vital for improving long-term neurological impairments in affected children.
Area of Science:
- Neurology
- Pediatrics
- Neuroscience
Background:
- Perinatal arterial ischemic stroke (PAIS) is a significant cause of long-term neurological deficits in children.
- Identifying etiologic and prognostic factors is critical for improving patient outcomes.
Purpose of the Study:
- To identify predictors of epilepsy and poor outcomes in children with PAIS.
- To analyze clinical, imaging, and EEG data for prognostic indicators.
Main Methods:
- Retrospective single-center study of 44 children diagnosed with PAIS (2008-2024).
- Analysis of clinical, neuroimaging (MRI), and electroencephalogram (EEG) data.
- Outcomes assessed using modified Rankin Scale (mRS) scores.
Main Results:
- Epilepsy developed in 14 patients (14.2% drug-resistant).
- Focal EEG slowing (OR=8.484) and cortical involvement (OR=6.857) predicted epilepsy.
- Poor outcomes (mRS≥3) associated with epilepsy, EEG slowing, and cortical involvement.
Conclusions:
- Early EEG and MRI findings are crucial predictors of long-term prognosis in PAIS.
- Further multicenter studies are recommended to validate and improve predictive models.
Background:
Perinatal arterial ischemic stroke (PAIS) is a major cause of long-term neurological impairments. Understanding its etiologic and prognostic factors is essential for improving outcomes.
Methods:
A retrospective single-center study was conducted on children diagnosed with PAIS between 2008 and 2024. Clinical, imaging, and EEG data were analyzed to identify predictors of epilepsy and poor outcomes based on modified Rankin Scale (mRS) scores.
Results:
A total of 44 patients (9 neonatal arterial ischemic stroke [NAIS], 35 Presumed perinatal arterial ischemic stroke [PPAIS]) with a mean follow-up of 6.49 years were included. Seizure was the first symptom in 45.5%, and focal motor deficit in 54.5%. The most affected artery was the middle cerebral artery (92%), particularly the M1 branch (36.4%). Cortical involvement was noted in 59.1%. Fourteen patients developed epilepsy; 14.2% were drug-resistant. Focal EEG slowing (odds ratio [OR] = 8.484, p = 0.019) and cortical involvement (OR = 6.857, p = 0.023) significantly predicted epilepsy. Poor mRS outcomes (≥3) were seen in 44.2%, and were associated with epilepsy (OR = 5.556, p = 0.016), EEG slowing (OR = 5.353, p = 0.035), and cortical involvement (OR = 7.467, p = 0.008).
Conclusions:
Early EEG and MRI findings are crucial in predicting long-term prognosis in PAIS. Further multicenter studies are needed to validate and enhance outcomes.
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