Language lateralization and outcome in perinatal stroke patients with different vascular types

Ilves, Nigul; Männamaa, Mairi; Laugesaar, Rael; Loorits, Dagmar; Vaher, Ulvi; Kool, Pille; Ilves, Pilvi

doi:10.1016/j.bandl.2022.105108

Cited by 9 publications

(11 citation statements)

References 62 publications

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“…2 Population studies have determined that 92.5% of people who are right-handed have left-sided language lateralization. 3 Language in children does not fully lateralize until age 5. 4 Given this, adults with acute ischemic stroke (AIS) to eloquent cortex have poor recovery.…”

Section: Discussionmentioning

confidence: 99%

“…Studies do highlight that 20%-25% of children with AIS in the perinatal period will have a language developmental delay. 3 However, 75% do not. 2 As such, there was appropriate suspicion of language re-organization in the above case given the early neurologic insult and seizure semiology.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, up to 67% of children with perinatal stroke will experience epilepsy 2 . Population studies have determined that 92.5% of people who are right‐handed have left‐sided language lateralization 3 . Language in children does not fully lateralize until age 5 4 .…”

Section: Discussionmentioning

confidence: 99%

“…The exact percentage of children who successfully re‐organize language following an in‐utero stroke is unknown. Studies do highlight that 20%–25% of children with AIS in the perinatal period will have a language developmental delay 3 . However, 75% do not 2 .…”

Section: Discussionmentioning

confidence: 99%

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When in doubt, return to fundamentals (seizure semiology)

Nordli

Beier

Galán³

2023

Epileptic Disorders

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This case of drug resistant focal epilepsy highlights several invaluable teaching points. Hypotheses grounded in seizure semiology provide the best framework to ensure accurate interpretation of diagnostic testing. Without a hypothesis, information gathered from tests can be difficult to linearly piece together and can lead to poor patient outcomes. The case also provides a real‐world conundrum of discordant test results that were ultimately rectified by re‐visiting the initial hypothesis and cross‐testing. Perinatal stroke continues to be a common etiology of drug resistant epilepsy. Patients can achieve seizure freedom and good quality of life with appropriate workup and in appropriate cases, surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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When in doubt, return to fundamentals (seizure semiology)

Nordli

Beier

Galán³

2023

Epileptic Disorders

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“…22,[29][30][31][32][33][34] The outcome depends on the initial size of the periventricular hemorrhagic infarction/periventricular venous infarction. 3,[34][35][36][37] Research of the risk factors for presumed antenatal periventricular venous infarction has been inadequate and evaluation of the causes of germinal matrix hemorrhage in fetuses is still insufficient. 8,9,14,17,20 Recent research shows that prenatal infection and chorioamnionitis may play a critical role in some term-born children with presumed antenatal periventricular venous infarction.…”

mentioning

confidence: 99%

High Prevalence of Collagenopathies in Preterm- and Term-Born Children With Periventricular Venous Hemorrhagic Infarction

et al. 2023

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Introduction The aim of this study was to evaluate genetic risk factors in term-born children with antenatal periventricular hemorrhagic infarction (PVHI), presumed antenatal periventricular venous infarction and periventricular hemorrhagic infarction in preterm neonates. Methods Genetic analysis and magnetic resonance imaging were performed in 85 children: term-born children (≥36 gestational weeks) with antenatal periventricular hemorrhagic infarction (n = 6) or presumed antenatal (n = 40) periventricular venous infarction and preterm children (<36 gestational weeks) with periventricular hemorrhagic infarction (n = 39). Genetic testing was performed using exome or large gene panel (n = 6700 genes) sequencing. Results Pathogenic variants associated with stroke were found in 11 of 85 (12.9%) children with periventricular hemorrhagic infarction/periventricular venous infarction. Among the pathogenic variants, COL4A1/A2 and COL5A1 variants were found in 7 of 11 (63%) children. Additionally, 2 children had pathogenic variants associated with coagulopathy, whereas 2 other children had other variants associated with stroke. Children with collagenopathies had significantly more often bilateral multifocal stroke with severe white matter loss and diffuse hyperintensities in the white matter, moderate to severe hydrocephalus, moderate to severe decrease in size of the ipsilesional basal ganglia and thalamus compared to children with periventricular hemorrhagic infarction/periventricular venous infarction without genetic changes in the studied genes ( P ≤ .01). Severe motor deficit and epilepsy developed more often in children with collagenopathies compared to children without genetic variants ( P = .0013, odds ratio [OR] = 233, 95% confidence interval [CI]: 2.8-531; and P = .025, OR = 7.3, 95% CI: 1.3-41, respectively). Conclusions Children with periventricular hemorrhagic infarction/periventricular venous infarction have high prevalence of pathogenic variants in collagene genes ( COL4A1/A2 and COL5A1). Genetic testing should be considered for all children with periventricular hemorrhagic infarction/periventricular venous infarction; COL4A1/A2 and COL5A1/A2 genes should be investigated first.

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Vascular syndrome predicts the development and course of epilepsy after perinatal stroke

Vaher,

Ilves,

Ilves

et al. 2024

Epileptic Disorders

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ObjectiveEpilepsy develops in one third of the patients after perinatal stroke. It is still unclear which vascular syndrome of ischemic stroke carries higher risk of epilepsy. The aim of the current study was to evaluate the risk of epilepsy according to the vascular syndrome of perinatal stroke.MethodsThe study included 39 children with perinatal arterial ischemic stroke (13 with anterior or posterior trunk of the distal middle cerebral artery occlusion, 23 with proximal or distal M1 middle cerebral artery occlusion and three with lenticulostriate arteria infarction), and 44 children with presumed perinatal venous infarction. Magnetic resonance imaging obtained at the chronic stage was used to evaluate the vascular syndrome of stroke.ResultsThe median follow‐up time was 15.1 years (95% CI: 12.4–16.5 years), epilepsy developed in 19/83 (22.9%) patients. The cumulative probability to be without epilepsy at 15 years was 75.4% (95% CI: 65.8–86.4). The probability of having epilepsy was higher in the group of proximal or distal M1 artery occlusion compared to patients with periventricular venous infarction (HR 7.2, 95% CI: 2.5–26, p = .0007). Patients with periventricular venous infarction had significantly more often status epilepticus or spike–wave activation in sleep ≥85% of it compared to patients with anterior or posterior trunk of the distal middle cerebral artery occlusion (OR = 81; 95% CI: 1.3–5046, p = .029).SignificanceThe emphasis of this study is placed on classifying the vascular syndrome of perinatal stroke and on the targeted follow‐up of patients for epilepsy until young adulthood. The risk for having epilepsy after perinatal stroke is the highest in children with proximal or distal M1 middle cerebral artery occlusion. Patients with periventricular venous infarction have a more severe course of epilepsy.

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Language lateralization and outcome in perinatal stroke patients with different vascular types

Cited by 9 publications

References 62 publications

When in doubt, return to fundamentals (seizure semiology)

When in doubt, return to fundamentals (seizure semiology)

High Prevalence of Collagenopathies in Preterm- and Term-Born Children With Periventricular Venous Hemorrhagic Infarction

Vascular syndrome predicts the development and course of epilepsy after perinatal stroke

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