Perinatal ischemic stroke: a five-year retrospective study in a level-III maternity

Abstract

Objective To study the incidence, clinical presentation, risk factors, imaging diagnosis, and clinical outcome of perinatal stroke.Methods Data was retrospectively collected from full-term newborns admitted to the neonatal unit of a level III maternity in Lisbon with cerebral stroke, from January 2007 to December 2011.Results There were 11 cases of stroke: nine were arterial ischemic stroke and two were cerebral venous sinus thrombosis. We estimated an incidence of arterial ischemic stroke of 1.6/5,000 births and of cerebral venous sinus thrombosis of 7.2/100,000 births. There were two cases of recurrent stroke. Eight patients presented with symptoms while the remaining three were asymptomatic and incidentally diagnosed. The most frequently registered symptoms (8/11) were seizures; in that, generalized clonic (3/8) and focal clonic (5/8). Strokes were more commonly left-sided (9/11), and the most affected artery was the left middle cerebral artery (8/11). Transfontanelle ultrasound was positive in most of the patients (10/11), and stroke was confirmed by cerebral magnetic resonance in all patients. Electroencephalographic recordings were carried out in five patients and were abnormal in three (focal abnormalities n=2, burst-suppression pattern n=1). Eight patients had previously identified risk factors for neonatal stroke which included obstetric and neonatal causes. Ten patients were followed up at outpatients setting; four patients developed motor deficits and one presented with epilepsy.Conclusions Although a modest and heterogeneous sample, this study emphasizes the need for a high level of suspicion when it comes to neonatal stroke, primarily in the presence of risk factors. The prevalence of neurological sequelae in our series supports the need of long-term follow-up and early intervention strategies.

Unilateral Basal Ganglia Infarctions in a Neonate Born to a Mother with Gestational Diabetes: Case Report

“…Although ultrasonography with Doppler imaging of cerebral blood flow is useful in the neonate who is too ill to transport [4,9]. Our neonate transfontanell US was normal, consistent with previous reported low sensitivity of US in PAIS especially in small, and deep seated infarction [10].…”

“…Copyright: ©2016 Kentab the literatures most reported PAIS in full term were left-sided, and involve the left middle cerebral artery (MCA) territory [2,9], with classical late thalamic atrophy [11]. This predominance of lesions on the left side is thought to be due to differences in vulnerability, maturation or to the presence of vascular asymmetries.…”

“…a. Gestational diabetes: Perinatal stroke in infant of diabetic mother is not uncommon. A recent retrospective study identified gestational diabetes as a major risk factor (8/11) followed by delivery complications especially hypoxia, and fetal distress [9], and in another case -control study it accounts for 16.1% versus 4.2%; P0.04 ,while maternal diabetes account for 3.4% among 32 neonates with PAIS [ 7]. Curry et al [13] reported 3 mothers with gestational diabetes and 2 with preexisting insulin-dependent diabetes among 60 cases of PAIS.…”

Letter to the editor on: Perinatal ischemic stroke: a five-year retrospective study in a level-III maternity. einstein (São Paulo). 2015;13(1):65-71.

“…I read with interest the article by Machado et al 1 This work could be greatly improved by including an adequate control group, turning a merely descriptive case-series into a case-control study, with evaluation of odds ratios, thus giving a valuable contribution aligned with other recently published investigations. 2 - 5 Some caution should be exercised when interpreting the incidence rates, since only symptomatic cases in the first 72 to 94 hours of life were included; whereas, according to the literature, some neonates present symptoms only after discharge and a few infants, within some months later.…”

“…Li com interesse o artigo de Machado et al 1 Este trabalho poderia ser melhorado se incluísse um grupo controle adequado, tornando uma mera série de casos descritiva em um estudo de caso-controle, com avaliação de odds ratios , e, assim, dando uma valiosa contribuição, alinhada a outras pesquisas publicadas recentemente. 2 - 5 A interpretação de taxas de incidência deve ser feita com cautela, pois apenas os casos sintomáticos, nas primeiras 72 a 94 horas de vida, foram incluídos; enquanto alguns recém-nascidos apresentam/apresentaram sintomas apenas após a alta, e outros lactentes, depois de alguns meses.…”