Background and objectives: Neonatal arterial ischemic stroke (NAIS) can lead to long-term neurological consequences such as cerebral palsy (CP). The aim of this study was to evaluate the predictive value of acute diffusion-weighted imaging (DWI) for CP by analyzing stroke volume next to brain structure involvement.
Methods: We included 37 term-born infants with NAIS prospectively registered in a nationwide pediatric stroke registry. DWI was performed between 0 and 8 days (mean 3 days) after stroke manifestation. Participants were neurologically assessed at the age of 2 years. We calculated the stroke volume (in mm3) and the ratio of the stroke volume to the volume of the entire brain (relative stroke volume). The predictive value of the relative stroke volume was analyzed and an optimal threshold for classification of children with high- and low-rates of CP was calculated. Predictive value of brain structure involvements and the prevalence of CP in combinations of different brain structures was also assessed.
Results: Sixteen children (43.2%) developed CP. Relative stroke volume significantly predicted CP (p < .001). Its optimal threshold for division into high- and low-rate of CP was 3.3%. The basal ganglia (OR 8.3, 95% CI 1.2-60.0) and basis pontis (OR 18.5, 95% CI 1.8-194.8) were independently associated with CP.
Conclusion: In addition to determining the involvement of affected brain areas, the volumetric quantification of stroke volume allows accurate prediction of cerebral palsy in newborns with NAIS.
Keywords: Cerebral palsy (CP); Diffusion-weighted imaging (DWI); Neonatal arterial ischemic stroke (NAIS); Prognosis; Stroke involvement; Stroke volume.
Copyright © 2019 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
Conflict of interest statement
Declaration of Competing Interest The authors have no conflicts of interest relevant to this article to disclose.
Long term motor function after neonatal stroke: Lesion localization above all.Hum Brain Mapp. 2015 Dec;36(12):4793-807. doi: 10.1002/hbm.22950. Epub 2015 Sep 10. Hum Brain Mapp. 2015. PMID: 26512551
Health related quality of life and manual ability 5 years after neonatal ischemic stroke.Eur J Paediatr Neurol. 2019 Sep;23(5):716-722. doi: 10.1016/j.ejpn.2019.08.002. Epub 2019 Aug 12. Eur J Paediatr Neurol. 2019. PMID: 31473077
Does diffusion tensor imaging-based tractography at 3 months of age contribute to the prediction of motor outcome after perinatal arterial ischemic stroke?Stroke. 2011 Dec;42(12):3410-4. doi: 10.1161/STROKEAHA.111.624858. Epub 2011 Oct 20. Stroke. 2011. PMID: 22020032
[Recommendations for imaging neonatal ischemic stroke].Arch Pediatr. 2017 Sep;24(9S):9S19-9S27. doi: 10.1016/S0929-693X(17)30327-5. Arch Pediatr. 2017. PMID: 28867033 Review. French.
Myth: cerebral palsy cannot be predicted by neonatal brain imaging.Semin Fetal Neonatal Med. 2011 Oct;16(5):279-87. doi: 10.1016/j.siny.2011.04.004. Epub 2011 Jun 1. Semin Fetal Neonatal Med. 2011. PMID: 21636334 Review.