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Newborn Brain Infarction: Clinical Aspects and Magnetic Resonance Imaging

Published online by Cambridge University Press:  07 November 2014

Akila Venkataraman ,
Peter B. Kingsley ,
Peter Kalina ,
Steven G. Pavlakis ,
Sharon Buckwald ,
Regina Spinazzola  and
Rita G. Harper
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Abstract

Objective: We describe the clinical and imaging studies of 11 full-term babies with neonatal stroke. We classify the neonatal non-hemorrhagic strokes as thrombotic, embolic, or global vascular insufficiency and determine if this classification is improved by adding magnetic resonance spectroscopy (MRS) and diffusion-weighted imaging (DWI) to conventional magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA).

Methods: Clinically, eight of the 11 babies presented with seizures, one with apnea, and two with lethargy. Conventional MRI and DWI were used to classify each infarct as being either borderzone or vascular distribution. The location of infarction revealed the presumed vascular pathophysiology.

Results: Infants were classified as having either embolic (bilateral middle cerebral artery, n=1), global ischemic (bilateral borderzone, n=2), or thrombotic infarction (unilateral middle cerebral artery, n=7; bilateral posterior cerebral arteries, n=1). DWI and MRS detected a small infarct better than conventional MRI in one patient. MRA showed abnormal intracranial arteries in three, all of who were in the thrombotic group. Even though MRS was more sensitive than conventional MRI in detecting ischemia/ infarction in one patient, in another there was no detectable lactate in the stroke region found on conventional MRI. Clinical presentation was similar in global ischemia and focal infarctions, but newborn stroke was more likely to present with lateralizing focal motor seizures. Seizures were the most common presenting sign, with a paucity of other focal neurological deficits.

Conclusion: MRI is the best approach to determine stroke pathophysiology. Brain infarction frequently presents with seizures. We speculate that the location and distribution of infarction might determine stroke timing, pathophysiology and outcome. Ongoing clinical studies will likely clarify this speculation.

Type
Original Research
Information
CNS Spectrums , Volume 9 , Issue 6 , June 2004 , pp. 436 - 444
Copyright
Copyright © Cambridge University Press 2004

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References

REFERENCES

1.Mercuri, E, Cowan, F. Cerebral infarction in the newborn infant: review of the literature and personal experience. Eur J Paediatr Neurol. 1999;3:255–263.CrossRefGoogle ScholarPubMed
2.Rollins, NK, Morris, MC, Evans, D, Perlman, JM. The role of early MR in the evaluation of the term infant with seizures. AJNR Am J Neuroradiol. 1994;15:239–248.Google Scholar
3.Sran, SK, Baumann, RJ. Outcome of neonatal strokes. Am J Dis Child. 1988;142:1086–1088.Google ScholarPubMed
4.Roodhoft, AM, Parizel, PM, Van Acker, KJ, et al.Idiopathic cerebral arterial infarction with paucity of symptoms in the full-term neonate. Pediatrics. 1987;80:381–385.CrossRefGoogle Scholar
5.Coker, SB, Beltran, RS, Myers, TF, Hmura, L. Neonatal stroke: description of patients and investigation into pathogenesis. Pediatr Neurol. 1988;4:219–223.CrossRefGoogle ScholarPubMed
6.Ment, LR, Duncan, CC, Ehrenkranz, RA. Perinatal cerebral infarction. Ann Neurol. 1984;16:559–568.CrossRefGoogle ScholarPubMed
7.Yokochi, K. Clinical profiles of subjects with subcortical leukomalacia and border-zone infarction revealed by MR. Acta Paediatr. 1998;87:879–883.CrossRefGoogle ScholarPubMed
8.Pavlakis, SG, Kingsley, PB, Harper, R, et al.Correlation of basal ganglia magnetic resonance spectroscopy with Apgar score in perinatal asphyxia. Arch Neurol. 1999;56:1476–1481.CrossRefGoogle ScholarPubMed
9.Mannino, FL, Trauner, DA. Stroke in neonates. J Pediatr. 1983;102:605–609.CrossRefGoogle ScholarPubMed
10.Clancy, R, Malin, S, Laraque, D, Baumgart, S, Younkin, D. Focal motor seizures heralding stroke in full-term neonates. Am J Dis Child. 1985;139:601–606.Google ScholarPubMed
11.Filipek, PA, Krishnamoorthy, KS, Davis, KR, Kuehnle, K. Focal cerebral infarction in the newborn: a distinct entity. Pediatr Neurol. 1987;3:141–147.CrossRefGoogle ScholarPubMed
12.Levy, SR, Abroms, IF, Marshall, PC, Rosquete, EE. Seizures and cerebral infarction in the full-term newborn. Ann Neurol. 1985;17:366–370.CrossRefGoogle ScholarPubMed
13.Trauner, DA, Mannino, FL. Neurodevelopmental outcome after neonatal cerebrovascular accident. J Pediatr. 1986;108:459–461.CrossRefGoogle ScholarPubMed
14.Bode, H, Strassburg, HM, Pringsheim, W, Künzer, W. Cerebral infarction in term neonates: diagnosis by cerebral ultrasound. Child Nerv Syst. 1986;2:195–199.CrossRefGoogle ScholarPubMed
15.Groenendaal, F, van der Grond, J, Witkamp, TD, de Vries, LS. Proton magnetic resonance spectroscopic imaging in neonatal stroke. Neuropediatrics. 1995;26:243–248.CrossRefGoogle ScholarPubMed
16.Ricci, PE Jr. Proton MR spectroscopy in ischemic stroke and other vascular disorders. Neuroimag Clin N Am. 1998;8:881–900.Google ScholarPubMed
17.Cowan, FM, Pennock, JM, Hanrahan, JD, Manji, KP, Edwards, AD. Early detection of cerebral infarction and hypoxic ischemic encephalopathy in neonates using diffusion-weighted magnetic resonance imaging. Neuropediatrics. 1994;25:172–175.CrossRefGoogle ScholarPubMed
18.Robertson, RL, Ben-Sira, L, Barnes, PD, et al.MR line-scan diffusion-weighted imaging of term neonates with perinatal brain ischemia. AJNR Am J Neuroradiol. 1999;20:1658–1670.Google ScholarPubMed
19.Flacke, S, Urbach, H, Folkers, PJM, et al.Ultra-fast three dimensional MR perfusion imaging of the entire brain in acute stroke assessment. J Magn Reson Imaging. 2000;11:250–259.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
20.Detre, JA, Alsop, DC. Perfusion magnetic resonance imaging with continuous arterial spin labeling: methods and clinical applications in the central nervous system. Eur J Radiology. 1999;30:115–124.CrossRefGoogle ScholarPubMed
21.Silver, RK, MacGregor, SN, Pasternak, JF, Neely, SE. Fetal stroke associated with elevated maternal anticardiolipin antibodies. Obstet Gynecol. 1992;80:497–499.Google ScholarPubMed
22.Perlman, JM, Rollins, NK, Evans, D. Neonatal stroke: clinical characteristics and cerebral blood flow velocity measurements. Pediatr Neurol. 1994:11:281–284.CrossRefGoogle ScholarPubMed
23.Guajardo, L, Stauss, A, Amster, J. Idiopathic cerebral infarction and upper limb ischemia in neonates. Am J Perinatol. 1994; 11:119–122.CrossRefGoogle ScholarPubMed
24.Gudinchet, F, Dreyer, JL, Payot, M, Duvoisin, B, Laurini, R. Imaging of neonatal arterial thrombosis. Arch Dis Child. 1991;66:1158–1159.CrossRefGoogle ScholarPubMed
25.Rios, A, Goyal, M, Kresch, MJ, Rao, SB, Brion, LP. Magnetic resonance imaging in full-term infants with repetitive focal seizures. J Perinatol. 1992;12:252–256.Google ScholarPubMed
26.Bouza, H, Dubowitz, LMS, Rutherford, M, Pennock, JM. Prediction of outcome in children with congenital hemiplegia: a magnetic resonance imaging study. Neuropediatrics. 1994;25:60–66.CrossRefGoogle ScholarPubMed
27.Messer, J, Haddad, J, Casanova, R. Transcranial Doppler evaluation of cerebral infarction in the neonate. Neuropediatrics. 1991;22:147–151.CrossRefGoogle ScholarPubMed
28.de Vries, LS, Groenendaal, F, Eken, P, van Haastert, IC, Rademaker, KJ, Meiners, LC. Infarcts in the vascular distribution of the middle cerebral artery in preterm and fullterm infants. Neuropediatrics. 1997;28:88–96.CrossRefGoogle ScholarPubMed
29.Mercuri, E, Cowan, F, Rutherford, M, Acolet, D, Pennock, J, Dubowitz, L. Ischaemic and haemorrhagic brain lesions in newborns with seizures and normal Apgar scores. Arch Dis Child. 1995;73:67–74.CrossRefGoogle ScholarPubMed
30.Estan, J, Hope, P. Unilateral neonatal cerebral infarction in full term infants. Arch Dis Child. 1997;76:88–93.CrossRefGoogle ScholarPubMed
31.Levene, MI, Trounce, JQ. Cause of neonatal convulsions: towards more precise diagnosis. Arch Dis Child. 1986;61:78–79.CrossRefGoogle ScholarPubMed
32.Raine, J, Davies, H, Gamsu, HR. Multiple idiopathic emboli in a full term neonate. Acta Paediatr Scand. 1989;78:644–646.CrossRefGoogle Scholar
33.Giroud, M, Fayolle, H, Martin, D, et al.Late thalamic atrophy in infarction of the middle cerebral artery territory in neonates: a prospective clinical and radiological study in four children. Child Nerv Syst. 1995;11:133–136.CrossRefGoogle ScholarPubMed
34.Aso, K, Scher, MS, Barmada, MA. Cerebral infarcts and seizures in the neonate. J Child Neurol. 1990;5:224–228.CrossRefGoogle ScholarPubMed