Neonatal posterior cerebral artery stroke: clinical presentation, MRI findings, and outcome

Dev Med Child Neurol. 2013 Mar;55(3):283-90. doi: 10.1111/dmcn.12055. Epub 2013 Jan 22.

Abstract

Aim: To report the clinical presentation, magnetic resonance imaging (MRI) findings, and follow-up data of newborn infants with perinatal arterial ischemic stroke in the territory of the posterior cerebral artery (PCA).

Method: Data on 18 newborn infants from three neonatal intensive care units (11 males, seven females) with an MRI-confirmed PCA stroke were analysed and reported. Infants were born at a mean gestational age of 38.7 weeks (SD 3.4) with a mean birthweight of 3244g (SD 850).

Results: Fourteen infants presented with clinical seizures. Five of these had associated hypoxic-ischemic encephalopathy, four had hypoglycaemia, and five had neither hypoxic-ischemic encephalopathy nor hypoglycaemia. Subclinical seizures were present in one infant with hypoxic-ischemic encephalopathy and one with meningitis. One preterm infant presented with apnoeas and one had hypoxic-ischemic encephalopathy without seizures. Neurodevelopmental follow-up of 17 children at a median age of 36 months (SD 28, range 12-120mo) showed five with a global delay. Two children with additional injury developed postneonatal epilepsy and one child with extensive injury developed hemiplegia. A visual field defect was observed in nine children (six hemianopia, three quadrantanopia). In the 11 children with a second MRI at 3 months, the asymmetry of the optic radiation correlated with the development of a visual field deficit.

Interpretation: Outcome after PCA stroke is fairly good, depending on additional brain injury. Follow-up is required, as subsequent visual field defects are frequently observed. Further research will be needed to clarify the role of hypoglycaemia in perinatal arterial ischemic stroke.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain Ischemia / diagnosis*
  • Brain Ischemia / etiology
  • Brain Ischemia / physiopathology
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Gestational Age
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Newborn, Diseases / physiopathology*
  • Infarction, Posterior Cerebral Artery / diagnosis*
  • Infarction, Posterior Cerebral Artery / etiology
  • Infarction, Posterior Cerebral Artery / physiopathology
  • Magnetic Resonance Imaging
  • Male
  • Retrospective Studies
  • Treatment Outcome