Bedside neurophysiological tests can identify neonates with stroke leading to cerebral palsy

• Published in: Clinical neurophysiology 2019-05, Vol.130 (5), p.759-766
• Main Authors: Nevalainen, Päivi, Metsäranta, Marjo, Toiviainen-Salo, Sanna, Lönnqvist, Tuula, Vanhatalo, Sampsa, Lauronen, Leena
• Format: Article
• Language: English
• Subjects: Brain - physiopathology; Cerebral palsy (CP); Cerebral Palsy - diagnosis; Cerebral Palsy - etiology; Cerebral Palsy - physiopathology; Electroencephalography; Electroencephalography (EEG); Evoked Potentials, Somatosensory - physiology; Female; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Neonatal intensive care; Neonatal seizures; Neonatal stroke; Somatosensory evoked potentials (SEP); Stroke - complications; Stroke - diagnosis; Stroke - physiopathology
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2019.02.017

•The unspecific symptoms of neonatal stroke challenge its bedside diagnosis and outcome prediction.•We show that EEG and SEPs can identify neonates with large middle cerebral artery stroke at bedside.•SEPs also proved to be accurate in predicting outcome after neonatal stroke. The unspecific symptoms of neonatal stroke still challenge its bedside diagnosis. We studied the accuracy of routine electroencephalography (EEG) and simultaneously recorded somatosensory evoked potentials (EEG-SEP) for diagnosis and outcome prediction of neonatal stroke. We evaluated EEG and EEG-SEPs from a hospital cohort of 174 near-term neonates with suspected seizures or encephalopathy, 32 of whom were diagnosed with acute ischemic or hemorrhagic stroke in MRI. EEG was scored for background activity and seizures. SEPs were classified as present or absent. Developmental outcome of stroke survivors was evaluated from medical records at 8- to 18-months age. The combination of continuous EEG and uni- or bilaterally absent SEP (n = 10) was exclusively seen in neonates with a middle cerebral artery (MCA) stroke (specificity 100%). Moreover, 80% of the neonates with this finding developed with cerebral palsy. Bilaterally present SEPs did not exclude stroke, but predicted favorable neuromotor outcome in stroke survivors (positive predictive value 95%). Absent SEP combined with continuous EEG background in near-term neonates indicates an MCA stroke and a high risk for cerebral palsy. EEG-SEP offers a bedside method for diagnostic screening and a reliable prediction of neuromotor outcome in neonates suspected of having a stroke.