Incidence and Outcomes of Symptomatic Neonatal Arterial Ischemic Stroke

Abstract

BACKGROUND AND OBJECTIVES: Neonatal arterial ischemic stroke (NAIS) is associated with considerable lifetime burdens such as cerebral palsy, epilepsy, and cognitive impairment. Prospective epidemiologic studies that include outcome assessments are scarce. This study aimed to provide information on the epidemiology, clinical manifestations, infarct characteristics, associated clinical variables, treatment strategies, and outcomes of NAIS in a prospective, population-based cohort of Swiss children. RESULTS: One hundred neonates (67 boys) had a diagnosis of NAIS. The NAIS incidence in Switzerland during this time was 13 (95% confidence interval [CI], 11-17) per 100 000 live births. Seizures were the most common symptom (95%). Eighty-one percent had unilateral (80% left-sided) and 19% had bilateral lesions. Risk factors included maternal risk conditions (32%), birth complications (68%), and neonatal comorbidities (54%). Antithrombotic and antiplatelet therapy use was low (17%). No serious side effects were reported. Two years after birth, 39% were diagnosed with cerebral palsy and 31% had delayed mental performance.CONCLUSIONS: NAIS in Switzerland shows a similar incidence as other population-based studies. About one-third of patients developed cerebral palsy or showed delayed mental performance 2 years after birth, and children with normal mental performance may still develop deficits later in life. WHAT'S KNOWN ON THIS SUBJECT:Neonatal arterial ischemic stroke is associated with later cerebral palsy and cognitive impairment. Many studies on neonatal ischemic stroke are limited by modest sample sizes, and prospective studies that include outcomes assessments are scarce. WHAT THIS STUDY ADDS:Results from this prospective, nationwide, population-based study provide information on the epidemiology, associated clinical variables, clinical manifestation, vascular distribution, and treatment of neonatal arterial ischemic stroke. The study also provides outcomes regarding motor function and cognition.

Delayed erythropoietin therapy improves histological and behavioral outcomes after transient neonatal stroke

“…Stroke during the neonatal period is a significant cause of death and long-term disability, occurring in as many as 1 in 2300 live births 1 . Most survivors have long-term motor or cognitive dysfunction, yet despite these lifelong effects no accepted post-injury treatment exists.…”

“…Identification and diagnosis of perinatal stroke is often delayed in neonates, who initially present with seizures 1 . Given the anti-apoptotic, pro-angiogenic and neurogenic effects of EPO in ischemia models, and the knowledge that the injury continues to evolve beyond the acute phase of ischemia, the question arises regarding the benefits of EPO initiated at more remote time periods.…”

Manual dexterity, but not cerebral palsy, predicts cognitive functioning after neonatal stroke

“…Neonatal arterial ischaemic stroke (NAIS) represents a unique model to study the impact of an early brain insult on development, as the lesion and its timing are well circumscribed. 6,7 In typically developing children, cognitive development is related to early sensorimotor abilities and experiences. 8 At 3 months, the motor repertoire is correlated with global intelligence, attention, and visual-motor integration at school age.…”

Neonatal seizures triple the risk of a remote seizure after perinatal ischemic stroke

“…In 54 children (62%), a physician diagnosis of cerebral palsy was recorded in the medical record. Children who presented with stroke during the neonatal period were more likely to have multiple infarcts (29% vs 3%, p 5 0.001), were younger when they began walking (median age of 13 [IQR 10-17] vs 16 [IQR [13][14][15][16][17][18][19][20][21][22] months, p 5 0.04), and were less likely to have a cerebral palsy diagnosis recorded (50% vs 85%, p 5 0.001) (table e-2). Otherwise, demographics, birth history, and years of follow-up were similar between the 2 groups.…”