Motor Outcomes After Neonatal Arterial Ischemic Stroke Related to Early MRI Data in a Prospective Study

Husson, B.; Hertz-Pannier, Lucie; Renaud, Cyrille; Allard, Dominique; Presles, Émilie; Landrieu, P.; Chabrier, Stéphane

doi:10.1542/peds.2009-3611

Cited by 90 publications

(65 citation statements)

References 20 publications

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“…57 Several studies have described the strong association between lesion topography and later phenotype of motor impairment. [58][59][60][61][62][63] Unilateral (left) middle cerebral artery (MCA) territory is the most frequent area of infarction (Fig. 4), leading to the most commonly observed adverse motor outcome of contralateral hemiplegia.…”

Section: Ischemic Perinatal Strokementioning

confidence: 99%

“…65,66 Refining outcome prediction has been the aim of several studies, given that the prevalence of cerebral palsy or motor impairment after IPS is variable, ranging from 24% to 68% across studies. 62,63,67,68 It has been suggested that predictors of later hemiplegia include involvement of the main branch of the MCA as opposed to distal branch infarction 59 ; involvement of basal ganglia, PLIC, and cerebral parenchyma as opposed to involvement of only 1 or 2 of these sites 58 ; and abnormal signal intensity in the ipsilateral descending corticospinal tract by diffusion-weighted imaging. 61 Few studies have also evaluated the utility of advanced quantitative MRI methods to refine prognostication in IPS.…”

Section: Ischemic Perinatal Strokementioning

confidence: 99%

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MRI for neurodevelopmental prognostication in the high-risk term infant

Massaro

2015

Seminars in Perinatology

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Section: Ischemic Perinatal Strokementioning

confidence: 99%

Section: Ischemic Perinatal Strokementioning

confidence: 99%

MRI for neurodevelopmental prognostication in the high-risk term infant

Massaro

2015

Seminars in Perinatology

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“…[3][4][5]18,19 However, only DTI at 3 months of age reached a PPV of 100% and was able to predict a correct outcome for all infants. DTI was of additional value in the infants whose neonatal DWI was inconclusive and in the infants with an unexpected suspect or abnormal motor repertoire at 3 months of age.…”

Section: Discussionmentioning

confidence: 98%

“…After PAIS, conventional MRI, especially diffusion-weighted imaging (DWI), [3][4][5] can be used to detect ischemic tissue and to predict motor outcome. [2][3][4][5] The observed restricted diffusion in the cerebral peduncle is predictive of Wallerian degeneration and subsequent unilateral motor deficits (UMD) and is therefore also referred to as "pre-Wallerian degeneration."…”

mentioning

confidence: 99%

“…[2][3][4][5] The observed restricted diffusion in the cerebral peduncle is predictive of Wallerian degeneration and subsequent unilateral motor deficits (UMD) and is therefore also referred to as "pre-Wallerian degeneration." [3][4][5] Diffusion tensor imaging (DTI) allows in vivo observation of the microstructural and architectural properties of the white matter. 6,7 Infants with perinatal brain injury who did develop UMD often show abnormalities in DTI parameters in later childhood.…”

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confidence: 99%

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Does Diffusion Tensor Imaging-Based Tractography at 3 Months of Age Contribute to the Prediction of Motor Outcome After Perinatal Arterial Ischemic Stroke?

Leemans

Northington³

et al. 2011

Stroke

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Background and Purpose-After perinatal arterial ischemic stroke, diffusion-weighted imaging (DWI) and early evaluation of spontaneous motor behavior can be used to predict the development of unilateral motor deficits. The aim of this study was to investigate whether diffusion tensor imaging-based tractography at 3 months of age contributes to this prediction. Methods-Twenty-two infants with unilateral perinatal arterial ischemic stroke were included and scanned during the neonatal period. DWI was used to assess restricted diffusion in the cerebral peduncle. At the age of 3 months, diffusion tensor imaging-based tractography of the corticospinal tracts was performed along with assessment of the movement repertoire. The role of DWI, diffusion tensor imaging, and motor assessment in predicting unilateral motor deficits were compared by calculating the positive and negative predictive values for each assessment. Results-Eleven infants (50%) showed abnormal motor behavior at 3 months with subsequent development of unilateral motor deficits in 8 as determined at follow-up (9 -48 months, positive predictive value 73%). Diffusion tensor imaging-based tractography correctly predicted the development of unilateral motor deficits in all 8 infants (positive predictive value 100%). A diagnostic neonatal DWI was available in 20 of 22 (91%) infants. Seven infants showed an abnormal DWI, resulting in unilateral motor deficits in 6 infants (positive predictive value 86%). All assessments had a negative predictive value of 100%. Conclusions-Diffusion tensor imaging-based tractography at 3 months can be used to predict neurodevelopmental outcome after perinatal arterial ischemic stroke. It has a similar predictive value as DWI in the neonatal period and can especially be of additional value in case of an indecisive neonatal DWI or unexpected abnormal early motor development. (Stroke. 2011;42:3410-3414.)

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A connectome‐based approach to assess motor outcome after neonatal arterial ischemic stroke

Harrach

Pretzel

Groeschel

et al. 2021

Ann Clin Transl Neurol

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Objective Studies of motor outcome after Neonatal Arterial Ischemic Stroke (NAIS) often rely on lesion mapping using MRI. However, clinical measurements indicate that motor deficit can be different than what would solely be anticipated by the lesion extent and location. Because this may be explained by the cortical disconnections between motor areas due to necrosis following the stroke, the investigation of the motor network can help in the understanding of visual inspection and outcome discrepancy. In this study, we propose to examine the structural connectivity between motor areas in NAIS patients compared to healthy controls in order to define the cortical and subcortical connections that can reflect the motor outcome. Methods Thirty healthy controls and 32 NAIS patients with and without Cerebral Palsy (CP) underwent MRI acquisition and manual assessment. The connectome of all participants was obtained from T1‐weighted and diffusion‐weighted imaging. Results Significant disconnections in the lesioned and contra‐lesioned hemispheres of patients were found. Furthermore, significant correlations were detected between the structural connectivity metric of specific motor areas and manuality assessed by the Box and Block Test (BBT) scores in patients. Interpretation Using the connectivity measures of these links, the BBT score can be estimated using a multiple linear regression model. In addition, the presence or not of CP can also be predicted using the KNN classification algorithm. According to our results, the structural connectome can be an asset in the estimation of gross manual dexterity and can help uncover structural changes between brain regions related to NAIS.

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Motor Outcomes After Neonatal Arterial Ischemic Stroke Related to Early MRI Data in a Prospective Study

Abstract: Accurate prediction of motor outcomes can be obtained from early MRI scans after neonatal AIS. The absence of involvement of the CST resulted in normal motor development in 94% of cases. CST involvement resulted in congenital hemiplegia in 66% of cases.

Cited by 90 publications

References 20 publications

MRI for neurodevelopmental prognostication in the high-risk term infant

MRI for neurodevelopmental prognostication in the high-risk term infant

Does Diffusion Tensor Imaging-Based Tractography at 3 Months of Age Contribute to the Prediction of Motor Outcome After Perinatal Arterial Ischemic Stroke?

A connectome‐based approach to assess motor outcome after neonatal arterial ischemic stroke

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