IPSS outlines neonatal stroke characteristics
MedWire News: Many babies diagnosed with stroke within the first weeks of life have signs of acute illness, show data from the International Pediatric Stroke Study (IPSS).
The IPSS investigators, led by Adam Kirton (Alberta Children's Hospital, Calgary, Canada), recruited 249 babies (from 30 centers across 10 countries) who were diagnosed with neonatal arterial ischemic stroke.
In contrast with previous studies, around 40% of the babies had evidence of acute illness, such as emergent cesarean delivery (26%), needed for resuscitation (30%), or acute systemic illness (23%). Babies with neonatal stroke are usually reported to be generally healthy, without encephalopathy, but to present with seizures.
Most (72%) babies did indeed present with seizures, and 63% had diffuse neurologic signs, most commonly abnormal tone or level of consciousness. Just 30% of the babies had focal neurologic signs, mostly lateralizing hemiparesis.
"Neonates were unlikely to present with focal deficits, which emphasizes the need for a high index of clinical suspicion and prompt neuroimaging to diagnose stroke," say Kirton et al.
They add: "Our findings support the use of MRI [magnetic resonance imaging] with diffusion-weighted sequences as the first-line imaging modality in most cases of neonatal encephalopathy, which facilitates the accurate diagnosis of neonatal [arterial ischemic stroke].
"The role of [computed tomography] scanning is limited and has little advantage over MRI but poses additional risk of radiation to the neonatal brain."
MRI was used for 92% of the babies in the current study, but just 53% underwent vascular imaging, despite the wide availability of noninvasive techniques and their recommendation in guidelines.
"Arterial dissection in neonates has been described and might represent an underrecognized entity with cervical imaging so underperformed," the team comments in the journal Pediatrics.
Cardiac factors, mostly complex congenital cardiac disease, were detected in 18% of the babies, and 19% had a possible thrombophilia.
On multivariate analysis, babies who needed resuscitation were 5.5-fold more likely to have multiple territory infarction than those not resuscitated. Intracranial hemorrhage occurred in 23% of babies, and this was significantly associated with bilateral infarction, although the confidence intervals (CIs) were wide.
The researchers speculate that the association between neonatal resuscitation and multiple infarcts could reflect underlying diseased placenta. But they add: "Potential reasons for the independent association observed between hemorrhage and bilateral lesions are less evident, and a wide CI should be interpreted with caution."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Eleanor McDermid