Presumed Perinatal Stroke

Ilves, Pilvi; Laugesaar, Rael; Loorits, Dagmar; Kolk, Anneli; Tomberg, Tiiu; Lõo, Silva; Talvik, Inga; Kahre, Tiina; Talvik, Tiina

doi:10.1177/0883073815609149

Cited by 26 publications

(24 citation statements)

References 33 publications

(93 reference statements)

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“…Ischemic stroke was classified as AIS or PVI using the criteria based on a previous study by Kirton and coworkers [4] and modified by Ilves and coworkers [3, 21]. Patients were only considered eligible for our preliminary study when (a) they had documented unilateral left-hemisphere AIS or PVI (for the sake of homogeneity in the study as perinatal stoke affects more often the left side according to previous studies [18]) but also in our database (68%); (b) they were aged 7–17; and (c) they were able to remain still for about 45 minutes without sedation and to follow instructions during the MRI investigation.…”

Section: Methodsmentioning

confidence: 99%

“…Ischemic lesions were classified by the location and extent as described earlier [3, 22]. Among the children with PVI, five had small periventricular white matter damage in one lobe (patients (1) to (5)), one child had unilateral ventricular enlargement (patient (6)), and four had large left-side periventricular porencephalic damage involving the periventricular area in several lobes (patients (7) to (10)) (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…Previous outcome studies of perinatal stroke have been mainly focused on an isolated clinical function: either motor function [1, 2, 4, 7, 9, 15] or cognitive function [3, 5, 8, 13–16]. …”

Section: Introductionmentioning

confidence: 99%

“…Based on clinical-radiographical findings, there are two main subtypes of perinatal stroke: arterial ischemic stroke (AIS) and periventricular venous infarction (PVI) [3, 4, 9, 18]. The AIS involves arterial occlusion mostly in the middle cerebral artery (MCA) territory [3, 4, 9, 18], comprising large areas in the parietal, temporal, and frontal cortex and/or in the basal ganglia including the corticospinal tract [2]. The PVI, in contrast, comprises purely subcortical areas, predominantly the periventricular white matter, but also other parts of the descending corticospinal tract [3, 9].…”

Section: Introductionmentioning

confidence: 99%

“…The AIS involves arterial occlusion mostly in the middle cerebral artery (MCA) territory [3, 4, 9, 18], comprising large areas in the parietal, temporal, and frontal cortex and/or in the basal ganglia including the corticospinal tract [2]. The PVI, in contrast, comprises purely subcortical areas, predominantly the periventricular white matter, but also other parts of the descending corticospinal tract [3, 9]. In both types of vascular injury, damage of the corticospinal tract leads to hemiparesis [1, 2, 6].…”

Section: Introductionmentioning

confidence: 99%

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Resting-State Functional Connectivity and Cognitive Impairment in Children with Perinatal Stroke

Ilves

Laugesaar

et al. 2016

Neural Plasticity

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Perinatal stroke is a leading cause of congenital hemiparesis and neurocognitive deficits in children. Dysfunctions in the large-scale resting-state functional networks may underlie cognitive and behavioral disability in these children. We studied resting-state functional connectivity in patients with perinatal stroke collected from the Estonian Pediatric Stroke Database. Neurodevelopment of children was assessed by the Pediatric Stroke Outcome Measurement and the Kaufman Assessment Battery. The study included 36 children (age range 7.6–17.9 years): 10 with periventricular venous infarction (PVI), 7 with arterial ischemic stroke (AIS), and 19 controls. There were no differences in severity of hemiparesis between the PVI and AIS groups. A significant increase in default mode network connectivity (FDR 0.1) and lower cognitive functions (p < 0.05) were found in children with AIS compared to the controls and the PVI group. The children with PVI had no significant differences in the resting-state networks compared to the controls and their cognitive functions were normal. Our findings demonstrate impairment in cognitive functions and neural network profile in hemiparetic children with AIS compared to children with PVI and controls. Changes in the resting-state networks found in children with AIS could possibly serve as the underlying derangements of cognitive brain functions in these children.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Resting-State Functional Connectivity and Cognitive Impairment in Children with Perinatal Stroke

Ilves

Laugesaar

et al. 2016

Neural Plasticity

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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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Epilepsy after perinatal stroke with different vascular subtypes

et al. 2018

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SummaryObjectiveWith an incidence up to 63 per 100,000 live births, perinatal stroke is an important cause of childhood epilepsy. The aim of the study was to find the prevalence of and predictive factors for epilepsy, and to describe the course of epilepsy in children with perinatal stroke with different vascular subtypes.MethodsPatients were retrieved from the Estonian Paediatric Stroke Database with follow‐up time at least 24 months. Patients were divided into 5 perinatal stroke syndromes: neonatal arterial ischemic stroke (AIS), neonatal hemorrhagic stroke, neonatal cerebral sinovenous thrombosis, presumed AIS, and presumed periventricular venous infarction.ResultsThe final study group included 73 children with perinatal stroke (39 boys). With a median follow‐up time of 8.6 years, epilepsy was diagnosed in 21/73 (29%) children, most of whom had AIS (17/21, 81%). The 18‐year cumulative poststroke epilepsy risk according to the Kaplan‐Meier estimator was 40.8% (95% confidence interval [CI] 20.7–55.9%). The median age at epilepsy diagnosis was 50 months (range 1 month to 18.4 years). Children with neonatal AIS had the highest risk of epilepsy, but children with presumed AIS more often had severe epilepsy syndromes. Cortical lesions (odds ratio [OR] 19.7, 95% CI 2.9–133), and involvement of thalamus (OR 9.8, 95% CI 1.8–53.5) and temporal lobe (OR 8.3, 95% CI 1.8–39.6) were independently associated with poststroke epilepsy.SignificanceThe risk for poststroke epilepsy after perinatal stroke depends on the vascular subtype. Patients with perinatal AIS need close follow‐up to detect epilepsy and start with antiepileptic treatment on time.

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Presumed Perinatal Stroke

Cited by 26 publications

References 33 publications

Resting-State Functional Connectivity and Cognitive Impairment in Children with Perinatal Stroke

Resting-State Functional Connectivity and Cognitive Impairment in Children with Perinatal Stroke

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

Epilepsy after perinatal stroke with different vascular subtypes

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