The role of brain territorial involvement and infection/inflammation in the long-term outcome of neonates with arterial ischemic stroke: A population-based cohort study

• Published in: Early human development 2021-07, Vol.158, p.105393-105393, Article 105393
• Main Authors: Vojcek, Eszter, Jermendy, Agnes, Laszlo, Anna M., Graf, Rozsa, Rudas, Gabor, Berenyi, Marianne, Seri, Istvan
• Format: Article
• Language: English
• Subjects: Corticospinal tract; Infection; Main middle cerebral artery stroke; Multiple strokes; Neonatal arterial ischemic stroke; Neurodevelopmental outcome
• ISSN: 0378-3782; 1872-6232
• DOI: 10.1016/j.earlhumdev.2021.105393

Neonatal arterial ischemic stroke (NAIS) carries the risk of significant long-term neurodevelopmental burden on survivors. To assess the long-term neurodevelopmental outcome of term neonates diagnosed with NAIS and investigate the associations among brain territorial involvement on MRI, clinical risk factors and neurodevelopmental outcomes. Population-based cohort study. Seventy-nine term neonates with NAIS confirmed by MRI born between 2007 and 2017. Long-term neurodevelopmental outcome assessed using the Bayley Scales of Infant Development-II, the Brunet-Lézine test and the Binet Intelligence scales-V. Follow-up was available in 70 (89%) of the subjects enrolled, at a median age of 60 months [IQR: 35–84]. Normal neurodevelopmental outcome was found in 43% of the patients. In a multivariable model, infants with main MCA stroke had an increased risk for overall adverse outcome (OR: 9.1, 95% CI: 1.7–48.0) and a particularly high risk for cerebral palsy (OR: 55.9, 95% CI: 7.8–399.2). The involvement of the corticospinal tract without extensive stroke also increased the risk for cerebral palsy/fine motor impairment (OR: 13.5, 95% CI: 2.4–76.3). Multiple strokes were associated with epilepsy (OR: 9.5, 95% CI: 1.0–88.9) and behavioral problems (OR: 4.4, 95% CI: 1.1–17.5) and inflammation/infection was associated with cerebral palsy (OR: 9.8, 95% CI: 1.4–66.9), cognitive impairment (OR: 9.2, 95% CI: 1.8–47.8) and epilepsy (OR: 10.3, 95% CI: 1.6–67.9). Main MCA stroke, involvement of the corticospinal tract, multiple strokes and inflammation/infection were independent predictors of adverse outcome, suggesting that the interplay of stroke territorial involvement and clinical risk factors influence the outcome of NAIS. •Clinical risk factors and MRI findings predict the outcome of neonates with arterial ischemic stroke.•The main middle cerebral artery stroke is a significant predictor of overall adverse outcome.•Corticospinal tract involvement is associated with adverse outcome and motor impairment.•Multiple strokes are associated with epilepsy and behavioral problems.•Infection/inflammation predicts cerebral palsy, cognitive deficit and epilepsy.