Clinical diversity of cerebral sinovenous thrombosis and arterial ischemic stroke in the neonate: a surveillance study.

Abstract Background Incidence, risk factors, clinical presentation, onset of symptoms and age at diagnosis differ between arterial ischemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT) in the neonate. Distinguishing these two entities early and clinically can be of eminent importance. Methods Active surveillance for AIS and CSVT was performed in 345 German pediatric hospitals. Reported cases were validated with questionnaires. Only cases confirmed by cerebral MRI were included in our analysis. Both groups of patients (AIS and CSVT) were compared with regard to age at diagnose, pattern of clinical symptoms and risk factors. Results Data on 144 AIS and 51 CSVT neonatal cases were collected from 2015 to 2017. The relative risk of AIS was 2.8 [95% CI 2.1; 3.9] times higher compared to CSVT. CSVT patients were more likely to be born premature (CSVT 14/48, 29.2%; AIS 19/140, 13.2%; p = 0.02), to have signs of perinatal acidosis (e.g. umbilical artery pH ≤ 7.1 30.2% CSVT vs. 13.5% AIS p = 0.01). Generalized seizures and lethargy were more likely to occur in infants with CSVT (p < 0.0001). Age at onset of symptoms and at time of diagnoses was shifted to older ages in CSVT (p < 0.0001). Conclusion The risk for AIS is about three times higher than for CSVT in neonates. A higher proportion of critically ill infants in CSVT and a later onset of symptoms may indicate that perinatal and postnatal risk factors are more important for CSVT than for AIS. The data point to the need for awareness of CSVT in critical ill infants.

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Clinical Diversity of Cerebral Sinovenous Thrombosis and Arterial Ischaemic Stroke in the Neonate: A Surveillance Study

Neonatology ◽

10.1159/000512526 ◽

2021 ◽

pp. 1-7

Author(s):

Anna-Lisa Sorg ◽

Mathias Klemme ◽

Rüdiger von Kries ◽

Ursula Felderhoff-Müser ◽

Andreas W. Flemmer ◽

...

Keyword(s):

Risk Factors ◽

Relative Risk ◽

Ischaemic Stroke ◽

Critically Ill ◽

Age At Onset ◽

Age At Diagnosis ◽

Cerebral Sinovenous Thrombosis ◽

Cerebral Mri ◽

Sinovenous Thrombosis ◽

Arterial Ischaemic Stroke

Introduction: Relative risk, risk factors, clinical presentation, onset of symptoms, and age at diagnosis differ between arterial ischaemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT) in neonates. Distinguishing these 2 entities in time clinically can be of eminent importance. Methods: Active surveillance for AIS and CSVT was performed in 345 German paediatric hospitals. Only cases confirmed by cerebral MRI were included in our analysis. Patients with AIS were compared to CSVT cases with regard to age at diagnosis, pattern of clinical symptoms, and risk factors. Results: Data on 144 AIS and 51 CSVT neonatal cases were collected from 2015 to 2017. The relative risk of AIS was 2.8 (95% CI 2.1; 3.9) times higher than that of CSVT. CSVT patients were more likely to be born premature (CSVT 14/48, 29.2%; AIS 19/140, 13.2%; p = 0.02) and to have signs of perinatal acidosis (e.g., umbilical artery pH ≤ 7.1 30.2% CSVT vs. 13.5% AIS p = 0.01). Generalized seizures and lethargy were more likely to occur in infants with CSVT (p < 0.0001). Age at onset of symptoms and at time of diagnoses was shifted to older ages in CSVT (p < 0.0001). Discussion/Conclusion: The risk for AIS is about 3 times higher than that for CSVT in neonates. A higher proportion of critically ill infants in CSVT and a later onset of symptoms may indicate that perinatal and postnatal risk factors are more important for CSVT than for AIS. The data underline the need for an increased awareness of CSVT in critically ill infants.

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Risk factors, types and outcomes of arterial ischemic stroke in Polish pediatric patients: a retrospective single-center study

Archives of Medical Science ◽

10.5114/aoms.2017.71805 ◽

2021 ◽

Vol 17 (1) ◽

pp. 62-70 ◽

Cited By ~ 1

Author(s):

Beata Sarecka-Hujar ◽

Ilona Kopyta ◽

Dorota Raczkiewicz

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Pediatric Patients ◽

Age At Onset ◽

Neurological Complications ◽

Arterial Ischemic Stroke ◽

Stroke Subtype ◽

Anterior Circulation ◽

Post Stroke ◽

Normal Outcome

IntroductionVarious neurological complications may occur as a consequence of arterial ischemic stroke (AIS) and have an impact on daily activity of the patients, costs of their medical care and rehabilitation. The aim of this study was to analyze risk factors, stroke symptoms and post-stroke consequences in Polish pediatric patients depending on stroke subtype.Material and methodsWe retrospectively reviewed 77 children under the age of 18 years following their first AIS. Patients were white, Polish Caucasians, recruited in the Department of Pediatric Neurology at the Medical University of Silesia in Katowice (Poland). Statistical analysis was performed using Statistica 12.0.ResultsGender differed significantly between stroke subgroups (p = 0.030). The presence of focal cerebral arteriopathy (FCA) and chronic diseases was associated with type of AIS (p = 0.003 and p = 0.050, respectively). An outcome without neurological deterioration (normal outcome) was observed in 43% of children with lacunar anterior circulation infarct (LACI). Hemiparesis was present in almost all children with total anterior circulation infarct (TACI), in two thirds of children with partial anterior circulation infarct (PACI) and in almost 50% of children with LACI or posterior circulation infarct (POCI). In every child with hemiplegia the stroke symptom evolved into hemiparesis at follow-up. Additionally, patients with a normal outcome were older at the time of AIS than those with at least one neurological consequence (OR = 0.894, p = 0.034).ConclusionsThe presence and number of neurological outcomes depend on stroke subtypes. A relation between the presence of post-stroke deficits and age at onset was observed. The odds of deficit after ischemic stroke decreases by an average of 10.6% if the child is 1 year older at the time of AIS.

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Predictors of Quality of Life in Pediatric Survivors of Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis

Journal of Child Neurology ◽

10.1177/0883073811408609 ◽

2011 ◽

Vol 26 (9) ◽

pp. 1186-1192 ◽

Cited By ~ 36

Author(s):

Sharon J. Friefeld ◽

Robyn Westmacott ◽

Daune MacGregor ◽

Gabrielle A. deVeber

Keyword(s):

Quality Of Life ◽

Ischemic Stroke ◽

Arterial Ischemic Stroke ◽

Cerebral Sinovenous Thrombosis ◽

Sinovenous Thrombosis

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Pediatric Stroke: Clinical Findings and Radiological Approach

Stroke Research and Treatment ◽

10.4061/2011/172168 ◽

2011 ◽

Vol 2011 ◽

pp. 1-11 ◽

Cited By ~ 7

Author(s):

Giuseppe Lanni ◽

Alessia Catalucci ◽

Laura Conti ◽

Alessandra Di Sibio ◽

Amalia Paonessa ◽

...

Keyword(s):

Ischemic Stroke ◽

Magnetic Resonance ◽

Hemorrhagic Stroke ◽

Clinical Findings ◽

Pediatric Stroke ◽

Arterial Ischemic Stroke ◽

Venous Circulation ◽

Cerebral Sinovenous Thrombosis ◽

First Choice ◽

Sinovenous Thrombosis

This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis) and hemorrhagic stroke. Etiopathology and main clinical findings are examined as well. Magnetic Resonance Imaging could be considered as the first-choice diagnostic exam, offering a complete diagnostic set of information both in the discrimination between ischemic/hemorrhagic stroke and in the identification of underlying causes. In addition, Magnetic Resonance vascular techniques supply further information about cerebral arterial and venous circulation. Computed Tomography, for its limits and radiation exposure, should be used only when Magnetic Resonance is not available and on unstable patients.

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Perinatal thrombosis: implications for mothers and neonates

Hematology ◽

10.1182/asheducation-2015.1.48 ◽

2015 ◽

Vol 2015 (1) ◽

pp. 48-52 ◽

Cited By ~ 3

Author(s):

Sarah H. O'Brien

Keyword(s):

Ischemic Stroke ◽

Treatment Strategies ◽

Perinatal Period ◽

Clinical Equipoise ◽

Arterial Ischemic Stroke ◽

Perinatal Stroke ◽

Behavioral Challenges ◽

Cerebral Sinovenous Thrombosis ◽

Sinovenous Thrombosis

Abstract Stroke is more likely to occur in the perinatal period than any other time in childhood, and these events can lead to a lifetime of intellectual and motor disabilities, epilepsy, and behavioral challenges. This review describes the epidemiology and natural history of perinatal arterial ischemic stroke (PAIS) and cerebral sinovenous thrombosis (CSVT), risk factors for these complications, recent evidence regarding treatment strategies, and current gaps in knowledge. Existing evidence demonstrates the multifactorial etiology of symptomatic ischemic stroke in neonates, which includes a combination of maternal, delivery, and neonatal factors. The importance of inherited thrombophilia in the pathophysiology and long-term outcomes of perinatal stroke requires additional study. At this time, there is no evidence to support routine extensive thrombophilia screening outside of a research setting. Despite the frequency of perinatal stroke and its association with substantial morbidity, treatment strategies are currently limited, and prevention strategies are nonexistent. Anticoagulation is rarely indicated in PAIS, and more work needs to focus on neuroprotective prevention and alternate treatment strategies. Anticoagulation does appear to be safe in CSVT and may prevent thrombus progression but clinical equipoise remains, and clinical trials are needed to obtain evidence regarding short- and long-term efficacy outcomes.

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