Short-term outcomes after a neonatal arterial ischemic stroke
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ORIGINAL ARTICLE
Short-term outcomes after a neonatal arterial ischemic stroke Mauricio A. López-Espejo 1
&
Marta Hernández Chávez 1 & Isidro Huete 2
Received: 25 August 2020 / Accepted: 12 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The purpose of this study is to determine the frequency and radiological predictors of recurrent acute symptomatic seizures (RASS) and motor impairment at discharge after a neonatal arterial ischemic stroke (NAIS). Methods In a nonconcurrent cohort study, 33 full-term newborns with NAIS confirmed by MRI are admitted into our hospital between January 2003 and December 2012. Stroke size, calculated as stroke volume divided by whole brain volume (WBV), was categorized as > or < 3.3% of WBV. A univariate analysis of categorical variables was performed using Fisher’s exact test. A multivariate analysis was performed using logistic regression models including all variables with a p value < 0.1 in the univariate analysis. Results The median age at NAIS was 2 days (IQR, 1–5.6), 36.4% were girls. The stroke size was > 3.3 of WBV in 48.5% of the cases, and 54.5% showed multifocal lesions. Involvement of the cerebral cortex (54.5%), thalamus (48.5%), posterior limb of the internal capsule (36.4%), basal ganglia (36.4%), and brainstem (28.2%) were found. At discharge, 45.5% of newborns had a motor deficit, and 27.3% had at least two seizures. Multivariate analyses revealed that stroke size > 3.3% of WBV (OR: 8.1, CI: 1.2–53.9) and basal ganglia involvement (OR: 12.8, CI: 1.7–95.4) predicted motor impairment at discharge. Cortical involvement of temporal and frontal lobes (OR: 14, CI: 2.2–88.1; and OR: 9.1, CI: 1.2–72.6) were predictive of RASS. Conclusion Stroke size and location are independent risk factors for adverse short-term neurological outcomes in full-term newborns following a NAIS. Keywords Perinatal stroke . Brain infarction . Neuroimaging . Neonatal seizures . Cerebral palsy
Introduction Perinatal strokes are a common group of cerebrovascular diseases that occur in over 1 in 3500 live births. The concept englobes disorders that differ in onset age (antenatal, postnatal), type of brain lesion (ischemic and hemorrhagic), and affected vascular compartment (arterial and venous). These events have a focal alteration of brain blood flow in common, which is detected by neuroradiological or neuropathological studies [1]. Neonatal
* Mauricio A. López-Espejo [email protected] 1
Unit of Neurology, Division of Pediatrics, Medical School, Pontificia Universidad Católica de Chile, Santiago, Chile
2
Radiology Department, Medical School, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
arterial ischemic stroke (NAIS) is a perinatal stroke due to focal arterial ischemia between birth and postnatal day 28 [2]. Data from developed countries have shown that cerebral palsy is a common consequence of NAIS; both size and stroke location are independently associated with adverse motor outcomes [3, 4]. Also, according to
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