Perinatal Arterial Ischemic Stroke in Northern Queensland

Abstract

Objectives Our objective was to review the occurrence, presentation, and associated risk factors of stroke in infants at a tertiary neonatal intensive care unit.

Study Design Inpatient electronic records identified infants between March 2002 and March 2011 who had perinatal arterial ischemic stroke.

Results Ten infants had perinatal arterial ischemic stroke, 50% were outborn, 20% were indigenous, and mortality was 30%. Median birth weight was 2970 g (range 1699 to 3443 g), and median gestation was 36 weeks (range 32 to 41 weeks). Perinatal arterial ischemic stroke were left sided in three, right sided in three, and bilateral in four. Presentation included four with seizures, four with apnea/sepsis, one with thrombosis, and one without symptoms. In 4 of 10 cases reported in this series, there was a maternal history of gestational diabetes, although the incidence of gestational diabetes in Australia is only 4.5%.

Conclusion The incidence of gestational diabetes mellitus in our cases appears to be very much higher than the average population. Larger studies are needed to determine if gestational diabetes mellitus is a risk factor for perinatal arterial ischemic stroke.

Keywords

neonatal stroke - perinatal stroke risk factors - neonatal seizures - gestational diabetes mellitus

• References

• 1 Lynch JK. Epidemiology and classification of perinatal stroke. Semin Fetal Neonatal Med 2009; 14: 245-249
• 2 Golomb MR, Garg BP, Edwards-Brown M, Williams LS. Very early arterial ischemic stroke in premature infants. Pediatr Neurol 2008; 38: 329-334
• 3 Golomb MR. Outcomes of perinatal arterial ischemic stroke and cerebral sinovenous thrombosis. Semin Fetal Neonatal Med 2009; 14: 318-322
• 4 Curry CJ, Bhullar S, Holmes J, Delozier CD, Roeder ER, Hutchison HT. Risk factors for perinatal arterial stroke: a study of 60 mother-child pairs. Pediatr Neurol 2007; 37: 99-107
• 5 Lee J, Croen LA, Backstrand KH , et al. Maternal and infant characteristics associated with perinatal arterial stroke in the infant. JAMA 2005; 293: 723-729
• 6 Roach ES, Golomb MR, Adams R , et al; American Heart Association Stroke Council; Council on Cardiovascular Disease in the Young. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke 2008; 39: 2644-2691
• 7 Raju TN, Nelson KB, Ferriero D, Lynch JK ; NICHD-NINDS Perinatal Stroke Workshop Participants. Ischemic perinatal stroke: summary of a workshop sponsored by the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke. Pediatrics 2007; 120: 609-616
• 8 Simchen MJ, Goldstein G, Lubetsky A, Strauss T, Schiff E, Kenet G. Factor v Leiden and antiphospholipid antibodies in either mothers or infants increase the risk for perinatal arterial ischemic stroke. Stroke 2009; 40: 65-70
• 9 Grabowski EF, Buonanno FS, Krishnamoorthy K. Prothrombotic risk factors in the evaluation and management of perinatal stroke. Semin Perinatol 2007; 31: 243-249
• 10 Nelson KB. Perinatal ischemic stroke. Stroke 2007; 38 (2, Suppl) 742-745
• 11 Leistra-Leistra MJ, Timmer A, van Spronsen FJ, Geven WB, van der Meer J, Erwich JJ. Fetal thrombotic vasculopathy in the placenta: a thrombophilic connection between pregnancy complications and neonatal thrombosis?. Placenta 2004; 25 (Suppl A) S102-S105
• 12 Nelson KB. Thrombophilias, perinatal stroke, and cerebral palsy. Clin Obstet Gynecol 2006; 49: 875-884
• 13 Lequin MH, Dudink J, Tong KA, Obenaus A. Magnetic resonance imaging in neonatal stroke. Semin Fetal Neonatal Med 2009; 14: 299-310
• 14 Miller V. Neonatal cerebral infarction. Semin Pediatr Neurol 2000; 7: 278-288
• 15 Barnette AR, Inder TE. Evaluation and management of stroke in the neonate. Clin Perinatol 2009; 36: 125-136
• 16 Templeton M. I IP-C. Gestational diabetes mellitus in Australia, 2005–2006. Cat. No. CVD 44. Canberra: AIHW; 2008
• 17 Rutherford MA, Ramenghi LA, Cowan FM. Neonatal stroke. Arch Dis Child Fetal Neonatal Ed 2011; ; August 17 (Epub ahead of print)
• 18 Monagle P, Chalmers E, Chan A , et al. Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 8th ed. Chest 2008; 133: 8875-9685
• 19 Fedrizzi E, Pagliano E, Andreucci E, Oleari G. Hand function in children with hemiplegic cerebral palsy: prospective follow-up and functional outcome in adolescence. Dev Med Child Neurol 2003; 45: 85-91
• 20 Reid DT. Benefits of a virtual play rehabilitation environment for children with cerebral palsy on perceptions of self-efficacy: a pilot study. Pediatr Rehabil 2002; 5: 141-148
• 21 Golomb MR, Saha C, Garg BP, Azzouz F, Williams LS. Association of cerebral palsy with other disabilities in children with perinatal arterial ischemic stroke. Pediatr Neurol 2007; 37: 245-249
• 22 Ricci D, Mercuri E, Barnett A , et al. Cognitive outcome at early school age in term-born children with perinatally acquired middle cerebral artery territory infarction. Stroke 2008; 39: 403-410