Impact of stroke volume on motor outcome in neonatal arterial ischemic stroke
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. We include...
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| Veröffentlicht in: | European journal of paediatric neurology 2020-03, Vol.25, p.97-105 |
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| creator | Wiedemann, Andreas Pastore-Wapp, Manuela Slavova, Nedelina Steiner, Leonie Weisstanner, Christian Regényi, Mária Steinlin, Maja Grunt, Sebastian Mori, Andrea Capone Bigi, Sandra Datta, Alexandre Fluss, Joël Hackenberg, Annette Keller, Elmar MacKay, Mark T. Maier, Olive Mercati, Danielle Marcoz, Jean-Pierre Poloni, Claudia Ramelli, Gian Paolo Regényi, Maria Schmid, Regula Schmitt-Mechelke, Thomas |
| description | 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.
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.
Sixteen children (43.2%) developed CP. Relative stroke volume significantly predicted CP (p |
| doi_str_mv | 10.1016/j.ejpn.2019.10.006 |
| format | Article |
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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.
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.
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.
•The exact determination of the lesion volume in newborns with an ischemic stroke allows a prognosis of later cerebral palsy.•The involvement of vulnerable regions such as basal ganglia and corticospinal tract is associated with poor motor prognosis.•Small strokes can co-affect multiple vulnerable brain structures with a high-risk of cerebral palsy.</description><identifier>ISSN: 1090-3798</identifier><identifier>EISSN: 1532-2130</identifier><identifier>DOI: 10.1016/j.ejpn.2019.10.006</identifier><identifier>PMID: 31740218</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Cerebral palsy (CP) ; Diffusion-weighted imaging (DWI) ; Neonatal arterial ischemic stroke (NAIS) ; Prognosis ; Stroke involvement ; Stroke volume</subject><ispartof>European journal of paediatric neurology, 2020-03, Vol.25, p.97-105</ispartof><rights>2019 European Paediatric Neurology Society</rights><rights>Copyright © 2019 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-659f8027cca539bd188085cf120f24468431804d671faf81d09aeba7f4deefa63</citedby><cites>FETCH-LOGICAL-c356t-659f8027cca539bd188085cf120f24468431804d671faf81d09aeba7f4deefa63</cites><orcidid>0000-0003-2830-1000</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1090379819303952$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31740218$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wiedemann, Andreas</creatorcontrib><creatorcontrib>Pastore-Wapp, Manuela</creatorcontrib><creatorcontrib>Slavova, Nedelina</creatorcontrib><creatorcontrib>Steiner, Leonie</creatorcontrib><creatorcontrib>Weisstanner, Christian</creatorcontrib><creatorcontrib>Regényi, Mária</creatorcontrib><creatorcontrib>Steinlin, Maja</creatorcontrib><creatorcontrib>Grunt, Sebastian</creatorcontrib><creatorcontrib>Mori, Andrea Capone</creatorcontrib><creatorcontrib>Bigi, Sandra</creatorcontrib><creatorcontrib>Datta, Alexandre</creatorcontrib><creatorcontrib>Fluss, Joël</creatorcontrib><creatorcontrib>Hackenberg, Annette</creatorcontrib><creatorcontrib>Keller, Elmar</creatorcontrib><creatorcontrib>MacKay, Mark T.</creatorcontrib><creatorcontrib>Maier, Olive</creatorcontrib><creatorcontrib>Mercati, Danielle</creatorcontrib><creatorcontrib>Marcoz, Jean-Pierre</creatorcontrib><creatorcontrib>Poloni, Claudia</creatorcontrib><creatorcontrib>Ramelli, Gian Paolo</creatorcontrib><creatorcontrib>Regényi, Maria</creatorcontrib><creatorcontrib>Schmid, Regula</creatorcontrib><creatorcontrib>Schmitt-Mechelke, Thomas</creatorcontrib><creatorcontrib>the Swiss Neuropediatric Stroke Registry Group</creatorcontrib><creatorcontrib>Swiss Neuropediatric Stroke Registry Group</creatorcontrib><title>Impact of stroke volume on motor outcome in neonatal arterial ischemic stroke</title><title>European journal of paediatric neurology</title><addtitle>Eur J Paediatr Neurol</addtitle><description>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.
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.
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.
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.
•The exact determination of the lesion volume in newborns with an ischemic stroke allows a prognosis of later cerebral palsy.•The involvement of vulnerable regions such as basal ganglia and corticospinal tract is associated with poor motor prognosis.•Small strokes can co-affect multiple vulnerable brain structures with a high-risk of cerebral palsy.</description><subject>Cerebral palsy (CP)</subject><subject>Diffusion-weighted imaging (DWI)</subject><subject>Neonatal arterial ischemic stroke (NAIS)</subject><subject>Prognosis</subject><subject>Stroke involvement</subject><subject>Stroke volume</subject><issn>1090-3798</issn><issn>1532-2130</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kM1LAzEQxYMotlb_AQ-yRy9bJ8l-ZMGLiB-Fihc9hzQ7wdTdTU2yBf97U1o9eprh8d5j5kfIJYU5BVrdrOe43gxzBrRJwhygOiJTWnKWM8rhOO3QQM7rRkzIWQhrAGgKVp2SCad1AYyKKXlZ9BulY-ZMFqJ3n5htXTf2mLkh6110PnNj1C4JdsgGdIOKqsuUj-htWmzQH9hbfQifkxOjuoAXhzkj748Pb_fP-fL1aXF_t8w1L6uYV2VjBLBaa1XyZtVSIUCU2lAGhhVFJQpOBRRtVVOjjKAtNApXqjZFi2hUxWfket-78e5rxBBlny7BrlPpxDFIxmnZ1Olbnqxsb9XeheDRyI23vfLfkoLcYZRrucModxh3WsKYQleH_nHVY_sX-eWWDLd7A6Yvtxa9DNrioLG1HnWUrbP_9f8A5NuD1Q</recordid><startdate>202003</startdate><enddate>202003</enddate><creator>Wiedemann, Andreas</creator><creator>Pastore-Wapp, Manuela</creator><creator>Slavova, Nedelina</creator><creator>Steiner, Leonie</creator><creator>Weisstanner, Christian</creator><creator>Regényi, Mária</creator><creator>Steinlin, Maja</creator><creator>Grunt, Sebastian</creator><creator>Mori, Andrea Capone</creator><creator>Bigi, Sandra</creator><creator>Datta, Alexandre</creator><creator>Fluss, Joël</creator><creator>Hackenberg, Annette</creator><creator>Keller, Elmar</creator><creator>MacKay, Mark T.</creator><creator>Maier, Olive</creator><creator>Mercati, Danielle</creator><creator>Marcoz, Jean-Pierre</creator><creator>Poloni, Claudia</creator><creator>Ramelli, Gian Paolo</creator><creator>Regényi, Maria</creator><creator>Schmid, Regula</creator><creator>Schmitt-Mechelke, Thomas</creator><general>Elsevier Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2830-1000</orcidid></search><sort><creationdate>202003</creationdate><title>Impact of stroke volume on motor outcome in neonatal arterial ischemic stroke</title><author>Wiedemann, Andreas ; Pastore-Wapp, Manuela ; Slavova, Nedelina ; Steiner, Leonie ; Weisstanner, Christian ; Regényi, Mária ; Steinlin, Maja ; Grunt, Sebastian ; Mori, Andrea Capone ; Bigi, Sandra ; Datta, Alexandre ; Fluss, Joël ; Hackenberg, Annette ; Keller, Elmar ; MacKay, Mark T. ; Maier, Olive ; Mercati, Danielle ; Marcoz, Jean-Pierre ; Poloni, Claudia ; Ramelli, Gian Paolo ; Regényi, Maria ; Schmid, Regula ; Schmitt-Mechelke, Thomas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-659f8027cca539bd188085cf120f24468431804d671faf81d09aeba7f4deefa63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Cerebral palsy (CP)</topic><topic>Diffusion-weighted imaging (DWI)</topic><topic>Neonatal arterial ischemic stroke (NAIS)</topic><topic>Prognosis</topic><topic>Stroke involvement</topic><topic>Stroke volume</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wiedemann, Andreas</creatorcontrib><creatorcontrib>Pastore-Wapp, Manuela</creatorcontrib><creatorcontrib>Slavova, Nedelina</creatorcontrib><creatorcontrib>Steiner, Leonie</creatorcontrib><creatorcontrib>Weisstanner, Christian</creatorcontrib><creatorcontrib>Regényi, Mária</creatorcontrib><creatorcontrib>Steinlin, Maja</creatorcontrib><creatorcontrib>Grunt, Sebastian</creatorcontrib><creatorcontrib>Mori, Andrea Capone</creatorcontrib><creatorcontrib>Bigi, Sandra</creatorcontrib><creatorcontrib>Datta, Alexandre</creatorcontrib><creatorcontrib>Fluss, Joël</creatorcontrib><creatorcontrib>Hackenberg, Annette</creatorcontrib><creatorcontrib>Keller, Elmar</creatorcontrib><creatorcontrib>MacKay, Mark T.</creatorcontrib><creatorcontrib>Maier, Olive</creatorcontrib><creatorcontrib>Mercati, Danielle</creatorcontrib><creatorcontrib>Marcoz, Jean-Pierre</creatorcontrib><creatorcontrib>Poloni, Claudia</creatorcontrib><creatorcontrib>Ramelli, Gian Paolo</creatorcontrib><creatorcontrib>Regényi, Maria</creatorcontrib><creatorcontrib>Schmid, Regula</creatorcontrib><creatorcontrib>Schmitt-Mechelke, Thomas</creatorcontrib><creatorcontrib>the Swiss Neuropediatric Stroke Registry Group</creatorcontrib><creatorcontrib>Swiss Neuropediatric Stroke Registry Group</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of paediatric neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wiedemann, Andreas</au><au>Pastore-Wapp, Manuela</au><au>Slavova, Nedelina</au><au>Steiner, Leonie</au><au>Weisstanner, Christian</au><au>Regényi, Mária</au><au>Steinlin, Maja</au><au>Grunt, Sebastian</au><au>Mori, Andrea Capone</au><au>Bigi, Sandra</au><au>Datta, Alexandre</au><au>Fluss, Joël</au><au>Hackenberg, Annette</au><au>Keller, Elmar</au><au>MacKay, Mark T.</au><au>Maier, Olive</au><au>Mercati, Danielle</au><au>Marcoz, Jean-Pierre</au><au>Poloni, Claudia</au><au>Ramelli, Gian Paolo</au><au>Regényi, Maria</au><au>Schmid, Regula</au><au>Schmitt-Mechelke, Thomas</au><aucorp>the Swiss Neuropediatric Stroke Registry Group</aucorp><aucorp>Swiss Neuropediatric Stroke Registry Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of stroke volume on motor outcome in neonatal arterial ischemic stroke</atitle><jtitle>European journal of paediatric neurology</jtitle><addtitle>Eur J Paediatr Neurol</addtitle><date>2020-03</date><risdate>2020</risdate><volume>25</volume><spage>97</spage><epage>105</epage><pages>97-105</pages><issn>1090-3798</issn><eissn>1532-2130</eissn><abstract>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.
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.
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.
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.
•The exact determination of the lesion volume in newborns with an ischemic stroke allows a prognosis of later cerebral palsy.•The involvement of vulnerable regions such as basal ganglia and corticospinal tract is associated with poor motor prognosis.•Small strokes can co-affect multiple vulnerable brain structures with a high-risk of cerebral palsy.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>31740218</pmid><doi>10.1016/j.ejpn.2019.10.006</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-2830-1000</orcidid></addata></record> |
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| ispartof | European journal of paediatric neurology, 2020-03, Vol.25, p.97-105 |
| issn | 1090-3798 1532-2130 |
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| source | Elsevier ScienceDirect Journals |
| subjects | Cerebral palsy (CP) Diffusion-weighted imaging (DWI) Neonatal arterial ischemic stroke (NAIS) Prognosis Stroke involvement Stroke volume |
| title | Impact of stroke volume on motor outcome in neonatal arterial ischemic stroke |
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