Neuroimaging and Neurological Outcomes in Perinatal Arterial Ischemic Stroke: A Systematic Review and Meta-Analysis

• Published in: Pediatric neurology 2024-08, Vol.157, p.19-28
• Main Authors: Pabst, Lisa, Hoyt, Catherine R., Felling, Ryan J., Smith, Alyssa E., Harpster, Karen, Pardo, Andrea C., Bridge, Jeffrey A., Jiang, Bin, Gehred, Alison, Lo, Warren
• Format: Article
• Language: English
• Subjects: Arterial ischemic stroke; Cerebral palsy; Epilepsy; Perinatal stroke
• ISSN: 0887-8994; 1873-5150; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2024.04.029

Prediction of outcomes in perinatal arterial ischemic stroke (PAIS) is challenging. We performed a systematic review and meta-analysis to determine whether infarct characteristics can predict outcomes in PAIS. A systematic search was conducted using five databases in January 2023. Studies were included if the sample included children with neonatal or presumed PAIS; if infarct size, location, or laterality was indicated; and if at least one motor, cognitive, or language outcome was reported. The level of evidence and risk of bias were evaluated using the Risk of Bias in Non-Randomized Studies of Interventions tool. Meta-analyses were conducted comparing infarct size or location with neurological outcomes when at least three studies could be analyzed. Eighteen full-text articles were included in a systematic review with nine included in meta-analysis. Meta-analyses revealed that small strokes were associated with a lower risk of cerebral palsy/hemiplegia compared with large strokes (risk ratio [RR] = 0.263, P = 0.001) and a lower risk of epilepsy (RR = 0.182, P