Background and Purpose-There are not very many epidemiological studies on perinatal stroke, and many authors suggest that this may be an underdiagnosed condition. The aim of the study was to estimate the incidence of perinatal arterial ischemic and hemorrhagic stroke in Estonia, to study the first clinical signs and to identify possible differences in predisposing factors and outcome between acutely and retrospectively diagnosed cases of perinatal stroke. Methods-A retro-and prospective study of acutely (within the first month) and retrospectively diagnosed ischemic and hemorrhagic cases of perinatal stroke was conducted in a children population born in the eastern and southern regions of Estonia during the years 1994 to 2003. Patients were identified from a pilot study, hospital records, and an inquiry of child neurologists and general practitioners. The diagnosis was confirmed in 38 (12 were diagnosed acutely and 26 retrospectively) cases by neuroradiology (MRI or CT). Results-The incidence rate of perinatal stroke in Estonia is 63 per 100 000 live births. Main clinical findings in the neonatal period were seizures, abnormalities of muscular tone, and disturbed level of alertness. Previously identified risk factors occurred in 32% of cases. Children with early diagnosis had more often adverse events during pregnancy and delivery (PϽ0.05) and developed more severe stage of hemiparesis compared with children with late diagnosis (PϽ0.05). Conclusions-The incidence rate of 63 per 100 000 live birth is higher than previously reported. Detailed analysis of the first signs of perinatal stroke may improve the early diagnostics of perinatal stroke.

To achieve effective rehabilitation and to enhance patients' well-being, it is important to improve the quality and amount of social support network, as well as to support patients' adequate coping efforts for promoting an active lifestyle.

This prospective study revealed maladaptive changes in the profile of coping strategies and an increase in optimism. As social support, satisfaction with support and health-related quality of life did not improve, then rehabilitation, social and psychological support are continuously needed.

The CACNA1A gene encodes the transmembrane pore-forming alpha-1A subunit of the Cav 2.1 P/Q-type voltage-gated calcium channel. Several heterozygous mutations within this gene, including nonsense mutations, missense mutations, and expansion of cytosine-adenine-guanine repeats, are known to cause three allelic autosomal dominant conditions-episodic ataxia type 2, familial hemiplegic migraine type 1, and spinocerebellar ataxia type 6. An association with epilepsy and CACNA1A mutations has also been described. However, the link with epileptic encephalopathies has emerged only recently. Here we describe two patients, sister and brother, with compound heterozygous mutations in CACNA1A. Exome sequencing detected biallelic mutations in CACNA1A: A missense mutation c.4315T>A (p.Trp1439Arg) in exon 27, and a seven base pair deletion c.472_478delGCCTTCC (p.Ala158Thrfs*6) in exon 3. Both patients were normal at birth, but developed daily recurrent seizures in early infancy with concomitant extreme muscular hypotonia, hypokinesia, and global developmental delay. The brain MRI images showed progressive cerebral, cerebellar, and optic nerve atrophy. At the age of 5, both patients were blind and bedridden with a profound developmental delay. The elder sister died at that age. Their parents and two siblings were heterozygotes for one of those pathogenic mutations and expressed a milder phenotype. Both of them have intellectual disability and in addition the mother has adult onset cerebellar ataxia with a slowly progressive cerebellar atrophy. Compound heterozygous mutations in the CACNA1A gene presumably cause early onset epileptic encephalopathy, and progressive cerebral, cerebellar and optic nerve atrophy with reduced lifespan. © 2016 Wiley Periodicals, Inc.

Plasticity of language function after brain damage can depend on maturation of the brain. Children with left-hemisphere perinatal (n = 7) or childhood stroke (n = 5) and 12 controls were investigated using functional magnetic resonance imaging. The verb generation and the sentence comprehension tasks were employed to activate the expressive and receptive language areas, respectively. Weighted laterality indices were calculated and correlated with results assessed by neuropsychological test battery. Compared to controls, children with childhood stroke showed significantly lower mean scores for the expressive (P < .05) and receptive (P = .05) language tests. On functional magnetic resonance imaging they showed left-side cortical activation, as did controls. Perinatal stroke patients showed atypical right-side or bilateral language lateralization during both tasks. Negative correlation for stroke patients was found between scores for expressive language tests and laterality index during the verb generation task. (Re)organization of language function differs in children with perinatal and childhood stroke and correlates with neurocognitive performance.

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Change in social support network may be an important resource for increasing quality of life in patients with subarachnoid haemorrhage not only through help provided by supporters but also indirectly, through increasing subjective well-being. The absence of subjective complaints in patients with subarachnoid haemorrhage is not necessarily related to better objective condition but rather to inadequately optimistic life orientation.

1 syripatho-adrenal and hypothalamo-pituitary-adrenocortical system paticnts with head injury.Neurol Scand 1997: 96: 52-58. 0 Munksgaard 1997.Tr, determine the role of the sympatho-adrenal (SAS) and hypothalamopituitary-adrenocortical system (HPAS) after head injury, the relationship between venous blood epinephrine (E), norepinephrine (NE), adrenocorticotropic hormone (ACTH), cortisol levels, and clinical condition was examined in 55 patients. These observations suggest that head injury causes mainly activation of the above-mentioned systems depending on the severity of trauma. An inverse correlation between the levels of E, NE and Glasgow Coma Scale score, indicating the severity of head injury was revealed. ACTH and cortisol were similarly related to the clinical condition, although the observed correlation was less expressed. The changes in hormonal levels were present during the whole research period (1 week), although a certain shift to normalization was observed. However, catecholamines and ACTH levels in plasma were relatively low in severely head-injured patients whose CT scans revealed serious alterations in the mesencephalic-diencephalic area. At the same time their cortisol levels obtained maximal values and their chance to survive was diminutive. The results o f this study indicate that investigation of hormones of SAS and HPAS might be useful as an additional method in the complex of ordinary examinations in establishing early prognosis in patients with brain injury.