Perilesional Gliosis Is Associated with Outcome after Perinatal Stroke

2021 ◽  
Author(s):  
Sabrina Yu ◽  
Charissa Lam ◽  
Siddharth Shinde ◽  
Andrea M. Kuczynski ◽  
Helen L. Carlson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Brain Injury ◽  
Motor Function ◽  
Developmental Plasticity ◽  
Infarct Volume ◽  
Population Based ◽  
Arterial Ischemic Stroke ◽  
Cross Sectional ◽  
Perinatal Stroke ◽  
Focal Brain Injury

AbstractPerinatal ischemic stroke results in focal brain injury and life-long disability. Hemiplegic cerebral palsy and additional sequelae are common. With no prevention strategies, improving outcomes depends on understanding brain development. Reactive astrogliosis is a hallmark of brain injury that has been associated with outcomes but is unstudied in perinatal stroke. We hypothesized that gliosis was quantifiable and its extent would inversely correlate with clinical motor function. This is a population-based, retrospective, and cross-sectional study. Children with perinatal arterial ischemic stroke (AIS) or periventricular venous infarction (PVI) with magnetic resonance (MR) imaging were included. An image thresholding technique based on image intensity was utilized to quantify the degree of chronic gliosis on T2-weighted sequences. Gliosis scores were corrected for infarct volume and compared with the Assisting Hand and Melbourne Assessments (AHA and MA), neuropsychological profiles, and robotic measures. In total, 42 children were included: 25 with AIS and 17 with PVI (median = 14.0 years, range: 6.3–19 years, 63% males). Gliosis was quantifiable in all scans and scores were highly reliable. Gliosis scores as percentage of brain volume ranged from 0.3 to 3.2% and were comparable between stroke types. Higher gliosis scores were associated with better motor function for all three outcomes in the AIS group, but no association was observed for PVI. Gliosis can be objectively quantified in children with perinatal stroke. Associations with motor outcome in arterial but not venous strokes suggest differing glial responses may play a role in tissue remodeling and developmental plasticity following early focal brain injury.

Abstract 29: Common Thrombophilias are not Associated With Specific Perinatal Stroke Diseases

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Colleen Curtis ◽  
Michael Leaker ◽  
Patti Massicotte ◽  
Amalia Floer ◽  
Aleksandra Mineyko ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Factor V Leiden ◽  
Population Based ◽  
Factor V ◽  
Arterial Ischemic Stroke ◽  
Chi Square ◽  
Perinatal Stroke ◽  
Potential Contributor ◽  
Prothrombin Gene ◽  
Disease Specific

Background: Perinatal stroke causes cerebral palsy and lifelong disability. Specific diseases are definable, including arterial and venous ischemic injuries, but pathophysiological mechanisms are poorly understood. Thrombophilia has long been considered a potential contributor but population-based, controlled, disease-specific studies are limited. Hypothesis: Thrombophilia is uncommon in children with perinatal stroke. Methods: Subjects were recruited from the Alberta Perinatal Stroke Project, a population-based cohort with MRI-classified perinatal strokes: neonatal arterial ischemic stroke (NAIS), arterial presumed perinatal ischemic stroke (APPIS), and fetal periventricular venous infarction (PVI). Standardized thrombophilia evaluations were performed prospectively (2008-2015) after 12 months of age on stroke cases and matched controls. Measures included protein C and S, antithrombin III, factors VIII/IX/XI, fibrinogen, lipoprotein a, lupus anticoagulant, and antiphospholipid antibodies. Groups were compared (ANOVA, chi-square), corrected for multiple comparisons. Results: A total of 252 children were studied (58 NAIS, 48 APPIS, 69 PVI, 77 controls). Of 14 parameters, no differences were observed in 12 including all common thrombophilias. Prothrombin times were shorter in arterial strokes compared to controls (p<0.001). Factor XI levels were higher in arterial and PVI strokes compared to controls (p=0.004). Rates of genetic thrombophilias including factor V Leiden, prothrombin gene, and MTHFR were low and comparable to population rates. Conclusion: Our prospective, population-based, controlled, disease-specific study suggests minimal association between perinatal stroke and thrombophilia. This does not exclude the possibility of disordered coagulation at the time of stroke but suggests testing in childhood is not indicated.

scholarly journals B.3 The incidence of perinatal stroke is 1:1200 births in Southern Alberta: Population-based incidence of disease-specific perinatal stroke

2021 ◽  
Vol 48 (s3) ◽  
pp. S16-S16
Author(s):  
M Dunbar ◽  
J Hodge ◽  
A Floer ◽  
A Kirton
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Case Series ◽  
Population Based ◽  
Arterial Ischemic Stroke ◽  
Stroke Incidence ◽  
Perinatal Stroke ◽  
Cerebral Sinovenous Thrombosis ◽  
Southern Alberta ◽  
Disease Specific

Background: Perinatal stroke encompasses six cerebrovascular syndromes which occur between the 20th week of gestation and the 28th post-natal day. Subtypes are neonatal arterial ischemic stroke (NAIS), neonatal cerebral sinovenous thrombosis (CSVT), neonatal hemorrhagic stroke (NHS), arterial presumed perinatal ischemic stroke (APPIS), periventricular venous infarction (PVI), and presumed perinatal hemorrhagic stroke (PPHS). Inconsistent terminology and lack of population-based case series has limited accurate measurement of disease-specific perinatal stroke incidence. Our objective was to define the incidence of the subtypes of perinatal stroke using a population-based cohort. Methods: The Alberta Perinatal Stroke Project is a research cohort established in 2008 in Southern Alberta. Case acquisition included retrospective hospital and ICD code searches (1990-2008) and prospective enrollment from all NICU and neurology/stroke clinics (2008-2017). Results: The overall incidence of perinatal stroke in Southern Alberta was 9.0 cases per 10,000 births, or 1:1200 births. Per 10,000 births, the incidence of each subtype was: NAIS = 3.2 (~1:3000), APPIS =1.2 (~1:8500), PVI = 1.5 (~1:6500), CSVT = 1.0 (~1:9900), NHS = 1.4 (~1/7300), PPHS = 0.1 (1/82,000). Conclusions: The overall incidence of perinatal stroke in Southern Alberta is 1:1200 live births. Population-based sampling of disease-specific states may explain why this rate is much higher than previous estimates

Neurocognitive outcome in a 6-year-old girl with a history of perinatal stroke

2011 ◽  
Vol 26 (S2) ◽  
pp. 1100-1100
Author(s):  
A. Matos-Pires ◽  
N. Cardoso-Pereira
Keyword(s):  
Working Memory ◽  
Ischemic Stroke ◽  
Verbal Learning ◽  
Arterial Ischemic Stroke ◽  
Intellectual Performance ◽  
Perinatal Stroke ◽  
Intellectual Outcome ◽  
History Of ◽  
Perinatal Arterial Ischemic Stroke

Perinatal Stroke involves an often poorly understood neurocognitive events affecting the fetus and the new born with a potential for serious intellectual outcome.Our aim is to present a case study on the issue of neurocognitive defects on domains such as intellectual performance, attention and vigilance, executive functioning, visual perception, speed of processing, verbal learning and memory, and working memory on a 6 year old girl with perinatal arterial ischemic stroke.

scholarly journals Head circumference trajectory in children with perinatal stroke

2021 ◽  
pp. 088307382199610
Author(s):  
Amanda Leong ◽  
Amalia Floer ◽  
Adam Kirton ◽  
Aleksandra Mineyko
Keyword(s):  
Ischemic Stroke ◽  
Head Circumference ◽  
Developmental Outcomes ◽  
Normal Growth ◽  
Fisher Exact Test ◽  
Arterial Ischemic Stroke ◽  
Neurodevelopmental Outcomes ◽  
Perinatal Stroke ◽  
Head Growth ◽  
Poor Outcome

Background: Perinatal stroke is a leading cause of hemiparetic cerebral palsy and lifelong disability. Neurodevelopmental outcomes are difficult to predict and markers of long-term poor outcome continue to be investigated. Deceleration in growth of head circumference has been associated with worse developmental outcomes in neonatal brain injury. We hypothesized that perinatal stroke would result in decreased rates of head growth during childhood that would be associated with worse developmental outcomes. Methods: Patients with magnetic resonance imaging (MRI)–confirmed neonatal arterial ischemic stroke and arterial presumed perinatal ischemic stroke were identified from a population-based research cohort (Alberta Perinatal Stroke Project). Demographics and occipital-frontal circumference data were collected from medical records. Head growth was compared to typically developing control charts using a 2-tailed t test. The Fisher exact test was used to examine associations between Pediatric Stroke Outcome Measures (PSOM) scores and occipital-frontal head circumference. Results: Three hundred fifteen occipital-frontal head circumference measurements were collected from 102 patients (48 female, 54 male), over a median of 3.2 years (standard deviation = 5.18, range = 0-18.3). After 3 months for female patients and 1 year for male patients, occipital-frontal head circumference deviated and remained below normal growth trajectories ( P < .05) with a large effect size (Cohen d >0.8). Poor outcome (PSOM ≥ 1) was associated with smaller occipital-frontal head circumference ( P < .05). Conclusion: Head growth deceleration is observed in children with perinatal arterial ischemic stroke and is associated with poor outcome. Head circumference may be a tool to alert clinicians to the potential of abnormal neurologic outcome.

Abstract TP406: Ipsilesional Myelination is Impaired in Children With Perinatal Arterial Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sabrina Yu ◽  
Helen Carlson ◽  
Adam Kirton
Keyword(s):  
Brain Injury ◽  
Neurological Disorders ◽  
Repeated Measures ◽  
Population Based ◽  
T Test ◽  
Biological Processes ◽  
Typically Developing ◽  
Inclusion Criteria ◽  
Perinatal Brain Injury ◽  
Perinatal Stroke

Introduction: Stroke is a leading cause of perinatal brain injury and cerebral palsy. Current therapeutic efforts focus on optimizing developmental curves but the biological processes dictating these outcomes are poorly understood. Alterations in myelination are recognized as a major determinant of outcome in preterm brain injury but are unexplored in perinatal stroke (PS). Hypothesis: Ipsilesional delays in myelination occur in children with PS and are associated with poor developmental outcome. Methods: Participants were identified through the Alberta Perinatal Stroke Project, a population-based research cohort. Inclusion criteria were: 1) MRI-confirmed, unilateral arterial PS, 2) T1-weighted MRI >6mo, 3) absence of other neurological disorders, 4) neurological outcome (Pediatric Stroke Outcome Measure, PSOM), and 5) motor assessments (Assisting Hand Assessment, AHA; Melbourne Assessment). FreeSurfer software measured hemispheric asymmetry in myelination intensity. A second method using ImageJ validated the detection of myelination asymmetry. Overall PSOM scores were classified as poor (>1) or not. Repeated measures ANOVA compared perilesional, ipsilesional remote, and contralesional homologous regions. Myelination ratios for stroke cases were compared to typically developing controls (t-test), PSOM scores (t-test), and motor assessments (Pearson’s correlation). Results: Nineteen arterial stroke cases (mean age: 13.73±4.0yo) and 27 controls (mean age: 12.52±3.7yo) were studied. Stroke cases showed a greater degree of asymmetry with lower myelination in the lesioned hemisphere, compared to controls (p<0.001). Myelination in perilesional regions was decreased compared to ipsilesional remote (p<0.001) and contralesional homologous areas (p<0.001). Ipsilesional remote regions were decreased compared to homologous regions on the contralesional hemisphere (p=0.009). Contralesional myelination was also less than controls (p<0.001). Myelination ratios were not associated with PSOM, AHA, or Melbourne scores (p=0.144, 0.218, 0.366 respectively). Conclusion: Myelination of uninjured brain in the lesioned hemisphere is altered in children with PS. Further study is required to determine clinical significance.

Symptom patterns in childhood arterial ischemic stroke: Analysis of a population-based study in Germany

2018 ◽  
Vol 230 (06) ◽  
pp. 319-325
Author(s):  
Lucia Gerstl ◽  
Raphael Weinberger ◽  
Rüdiger von Kries ◽  
Florian Heinen ◽  
Andreas Sebastian Schroeder ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Symptoms ◽  
Population Based ◽  
Case Definition ◽  
Childhood Stroke ◽  
Older Children ◽  
Arterial Ischemic Stroke ◽  
Focal Neurological Deficit ◽  
Symptom Patterns ◽  
Specific Symptoms

Hintergrund Die zeitliche Verzögerung zwischen Symptombeginn und Diagnose ist eine Herausforderung in der Behandlung von Kindern mit arteriell ischämischem Schlaganfall. Frühere Studien zur klinischen Präsentation beschäftigten sich v. a. mit kumulativen Symptomen. Zielsetzung Ziel dieser Studie ist es, mögliche Symptommuster aufzuzeigen. Methoden In einer aktiven Beobachtungsstudie zwischen 01/2015 und 12/2016 (ESPED-Studie) wurden Kinder mit Erstdiagnose eines arteriell ischämischen Schlaganfalls eingeschlossen. Isoliert auftretende Erstsymptome wurden verschiedenen Symptomkombinationen gegenübergestellt. Zudem wurde untersucht, inwieweit ein als „akut“ oder „progredient“ klassifiziertes Auftreten der Symptome Rückschlüsse auf die zugrundeliegende Ätiologie erlaubt. Ergebnisse Es wurden 99 Kinder in die Studie eingeschlossen. Unabhängig vom Alter traten überwiegend fokale Symptome auf (86%). Krampfanfälle als Initialsymptom wurden insbesondere bei Säuglingen beschrieben (67%), wohin-gegen diffuse, unspezifische Symptome vor allem bei Vorschulkindern (38%) und älteren Kindern (59%) auftraten. Isoliert traten fokale Symptome bei 37 Kindern auf, 48 Kinder zeigten zusätzlich unspezifische Symptome, darunter auch 9 Kinder mit Krampfanfällen. Isolierte unspezifische Symptome zeigten sich lediglich bei 7 Kindern, 2 Kinder wurden nur mit Krampfanfällen symptomatisch. Die Akuität des Symptombeginns wurde bei 53/78 als „akut“ und bei “25/78 Fällen als „progredient“ klassifiziert, lieferte jedoch keinen Hinweis auf die zugrundeliegende Ätiologie. Schlussfolgerung Jedes neue fokal neurologische Defizit sollte unabhängig vom Auftreten (isoliert oder kombiniert, akut oder progredient) an einen kindlichen Schlaganfall denken lassen. Background Time delay between onset of clinical symptoms and diagnosis is a challenge in childhood arterial ischemic stroke. Most previous studies reported cumulative symptoms. Objective We attempted to identify typical symptom patterns and assessed their emergence in childhood stroke. Methods Prospective active surveillance in ESPED, a hospital based Pediatric Surveillance Unit for rare diseases in Germany, between January 2015 and December 2016. Case definition: first diagnosis of a radiologically confirmed arterial ischemic stroke. Symptom patterns were identified as occurring in isolation or in combination. We distinguished acute vs. progressive onset. We ascertained risk factors to identify the possible etiology. Results 99 children with childhood arterial ischemic stroke were reported. Focal symptoms were the predominant presenting feature (86%), independent of age. Seizures were more often seen in infants < 1 year (67%), whereas diffuse symptoms were more present in pre-school children (38%) and older children (59%). 37 children had focal features alone and 48 additional non-specific features, including 9 with seizures. Isolated non-specific features accounted for 7 cases, and 2 children had (focal) seizures as the only symptom. In 77% of all cases at least one risk factor was identified. The emergence of symptoms was acute in 53/78 cases and progressive in 25/78 cases. The pattern of emergence was unrelated to the underlying etiology. Conclusions Any new focal neurological deficit in isolation, or associated with seizures or further non-specific symptoms should alert to childhood stroke.

scholarly journals KADAR FIBRIN MONOMER DAN UKURAN INFARK DI STROK ISKEMIK AKUT

2016 ◽  
Vol 20 (3) ◽  
pp. 171
Author(s):  
Ani Kartini ◽  
Mansyur Arif ◽  
Hardjoeno Hardjoeno
Keyword(s):  
Ischemic Stroke ◽  
Infarct Size ◽  
Acute Ischemic Stroke ◽  
Thrombus Formation ◽  
Infarct Volume ◽  
Cross Sectional Study ◽  
Cerebral Infarct ◽  
Cross Sectional ◽  
Fibrin Monomer ◽  
Significant Difference

Coagulation activation and thrombosis frequently exist in ischemic stroke, thrombus formation can be detected early by the presence of fibrin monomer. The purpose of this study was to know the correlation of fibrin monomer level with cerebral infarct size in acute ischemic stroke patients. This was a cross sectional study with a total of 39 samples. The fibrin monomer level was determined by immunoturbidimetry method using STA-Compact and the measurement of the infarct size was done by CT scan of the head using Broderick formula. The results of this study showed that the median level of fibrin monomer in acute ischemic stroke with nonlacunar infarct type and lacunar infarct type were 14.46 μg/mL and 4.29 μg/mL, respectively. Mann-Whitney test showed there was a significant difference of fibrin monomer levels between nonlacunar infarct type and the lacunar type, p=0.000. The cut-off point analysis result of the fibrin monomer level was 5.96 μg/mL with a sensitivity of 88.9% and specificity of 76.4%, respectively. Spearman correlation test showed that fibrin monomer level was positively correlated with cerebral infarct volume in acute ischemic stroke (r=0.56, p=0.000). Based on this study, it can be concluded that fibrin monomer level can be used as a marker to predict the type of cerebral infarct and volume of acute ischemic stroke as well.

Young Adults With Traumatic Brain Injury in Long-Term Care Homes: A Population-Based Study

2010 ◽  
Vol 11 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Angela Colantonio ◽  
Dana Howse ◽  
Jigisha Patel
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Long Term Care ◽  
Secondary Data ◽  
Population Based ◽  
Care Homes ◽  
Care Needs ◽  
Cross Sectional ◽  
Term Care

AbstractThe aim of this research was to identify the number and characteristics of adults under the age of 65 with a diagnosis of traumatic brain injury (TBI) living in long-term care homes (nursing homes, homes for the aged and charitable homes) in Ontario, Canada. Methods: The study used a cross-sectional design. Secondary data analysis of a comprehensive provincial database of long-term care homes was conducted. Results: Of the 399 residents coded as having a TBI, 154 were < 65 years of age. Virtually all residents were limited in personal care and required assistance for eating (94.2%), toileting (92.2%) and dressing (99.4%). A large percentage also required care for challenging behaviours, while care needs due to substance abuse was common among 12.3% of TBI residents. Conclusion: As similar research in Australia has found, young persons in long-term care homes in Ontario, Canada, have high level personal health needs, however the appropriateness of this environment is questionable.

Diffusion imaging of cerebral diaschisis in childhood arterial ischemic stroke

2016 ◽  
Vol 11 (9) ◽  
pp. 1028-1035 ◽  
Author(s):  
Adam Kirton ◽  
Elizabeth Williams ◽  
Michael Dowling ◽  
Sarah Mah ◽  
Jacquie Hodge ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Diffusion Weighted Imaging ◽  
Infarct Volume ◽  
Resonance Imaging ◽  
Arterial Ischemic Stroke ◽  
Diffusion Weighted ◽  
Motor Outcome

Background Diffusion-weighted imaging magnetic resonance imaging may detect changes in brain structures remote but connected to stroke consistent with neuropathological descriptions of diaschisis. Early diffusion-weighted imaging demonstrates restriction in corticospinal pathways after arterial ischemic stroke of all ages that correlates with motor outcome. Aim/hypothesis We hypothesized that cerebral diaschisis is measurable in childhood arterial ischemic stroke and explored associations with outcome. Methods This sub-study of the validation of the Pediatric NIH Stroke Scale study prospectively enrolled children with acute arterial ischemic stroke and both acute and early follow-up (5–14 days) diffusion-weighted imaging. Inclusion criteria were (1) unilateral middle cerebral artery arterial ischemic stroke, (2) acute and subacute diffusion-weighted imaging ( b = 1000), and (3) 12 month neurological follow-up (Pediatric Stroke Outcome Measure). A validated method using ImageJ software quantified diffusion-weighted imaging diaschisis in anatomically connected structures. Diaschisis measures were corrected for infarct volume, compared to age, imaging timing, and outcomes (Chi square/Fisher, Mann–Whitney test). Results Nineteen children (53% male, median 8.1 years) had magnetic resonance imaging at medians of 21 and 168 h post-stroke onset. Diaschisis was common and evolved over time, observed in one (5%) on acute but eight (42%) by follow-up diffusion-weighted imaging. Thalamic and callosal diaschisis were most common (5, 26%). Estimates of perilesional diaschisis varied (54 ± 18% of infarct volume). Children with diaschisis tended to be younger (7.02 ± 5.4 vs. 11.82 ± 4.3 years, p = 0.08). Total diaschisis score was associated with poor cognitive outcomes ( p = 0.03). Corticospinal tract diaschisis was associated with motor outcome ( p = 0.004). Method reliability was excellent. Conclusions Diffusion-weighted imaging diaschisis occurs in childhood arterial ischemic stroke. Mistaking diaschisis for new areas of infarction carries important clinical implications. Improved recognition and study are required to establish clinical relevance.

Abstract 389: Gestational Inflammation and Perinatal Arterial Ischemic Stroke: A Causal Connection?

2014 ◽  
Vol 34 (suppl_1) ◽  
Author(s):  
Clemence Guiraut ◽  
Nicole Cauchon ◽  
Martin Lepage ◽  
Guillaume Sebire
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Arteries ◽  
Arterial Occlusion ◽  
Carotid Bifurcation ◽  
Causal Connection ◽  
Arterial Ischemic Stroke ◽  
Motor Impairments ◽  
Perinatal Stroke ◽  
Clinical Model ◽  
Hemiplegic Cerebral Palsy

Introduction: Perinatal arterial ischemic strokes affect about 1/3,000 newborn and are the main cause of hemiplegic cerebral palsy. The large cerebral arteries from the anterior system, namely the intra-cranial carotid bifurcation, are the most affected, ischemic stroke being located in its territory in 85% of cases. The classic, but unproven, pathophysiological hypothesis postulated that arterial occlusion was caused by emboli from placental origin. This remains controversial due to the major unbalance of brain infarcts between anterior and posterior distribution, and to the absence of associated extra-cerebral infarcts. A new pathophysiological perspective emerged from the epidemiological association between gestational inflammation and perinatal stroke. Our hypothesis is that materno-foetal inflammation, induced by gestational exposure to pathogens, leads to a site-specific vasculitis affecting the carotid bifurcation and then triggering a focal thrombosis. Material and methods: Dams were injected with saline or lipopolysaccharide (LPS) from Escherichia coli (200 μg/kg/12h) between gestational day (G) 21 and 22. Brains were harvested at G21, G22 and postnatal day 1 (P1). At P1, a prothrombotic stress (transcutaneous photothrombosis) was applied on middle cerebral arteries to compare its susceptibility to thrombosis between LPS-exposed or unexposed pups. Immunohistochemistry and ELISA detected maternal, placental and fetal/neonatal inflammatory markers. Results: Our results showed a maternal, placental and fetal inflammation mediated by IL-1β, TNF-α and MCP-1 as well as an arterial inflammation in relation with the clinical pattern of perinatal arterial ischemic strokes. LPS+photothrombosis pups presented ischemic strokes and motor impairments, which were not detected when photothrombosis was applied without prior treatment with LPS. Conclusion: Preliminary results from our new pre-clinical model support our hypothesis of increased susceptibility of anterior cerebral arteries to gestational inflammation, and open a new vasculitic pathophysiological avenue to understand perinatal stroke.

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