scholarly journals Perinatal Arterial Ischaemic Stroke In Neonate

2018 ◽  
Vol 08 (02) ◽  
pp. 123-125
Author(s):  
Anila Haroon ◽  
Shakeel Ahmed ◽  
Syed Rehan Ali
Keyword(s):  
Cerebral Palsy ◽  
Ischemic Stroke ◽  
Health Care Providers ◽  
Developing World ◽  
Perinatal Period ◽  
Care Providers ◽  
Arterial Ischemic Stroke ◽  
Perinatal Stroke ◽  
True Incidence ◽  
Hemiplegic Cerebral Palsy

Arterial ischemic stroke (AIS) is not uncommon in neonates, but in large part of developing world it has been missed and remains undiagnosed because of lack of resources and insufficient engagement by health care providers. The incidence of ischemic perinatal stroke ranges between 1 in 200 No, to 1 in 5000 births and is reported to be responsible for 30% to 50% of congenital hemiplegic cerebral palsy (CP) who were born at term or late preterm gestations. The true incidence of AIS from the developing world is not known as neuroimaging facilities are available in few centers; most of these cases remain undiagnosed. Over the past decades, ischemic perinatal stroke has emerged as an important cause of brain injury in the perinatal period and remains a leading cause of cerebral palsy. We are reporting a 3 days old male baby who presented with refractory seizures, subsequently diagnosed as arterial ischemic stroke

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.

scholarly journals Perinatal thrombosis: implications for mothers and neonates

Hematology ◽  
2015 ◽  
Vol 2015 (1) ◽  
pp. 48-52 ◽  
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.

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.

scholarly journals Epilepsy in children with perinatal arterial ischemic stroke

2021 ◽  
Author(s):  
Fabienne Kühne ◽  
Alexander Jungbluth ◽  
Joanna Schneider ◽  
Christoph Bührer ◽  
Christine Prager ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Ischemic Stroke ◽  
Neonatal Period ◽  
Refractory Epilepsy ◽  
Late Onset ◽  
Cognitive Outcome ◽  
Response To Treatment ◽  
Arterial Ischemic Stroke ◽  
Structural Epilepsy ◽  
Drug Refractory Epilepsy

Purpose: Perinatal ischemic stroke (PIS) is a frequent cause for perinatal brain structure defects resulting in epilepsy, cerebral palsy and disability. Since the severity of symptoms is variable, the aim of this study was to evaluate the outcome of children with PIS and seizures/epilepsy to aid parental counseling and therapy decisions. Material: We studied retrospectively patients with arterial PIS and structural epilepsy or seizures in the newborn treated at a single center in 2000-2019. Specifically, signs and symptoms of cerebral palsy (CP), developmental and motor delay, epilepsy and thrombophilia were assessed. Results: From the identified 69 individuals with arterial PIS, we only included the 50 patients (64% male) who had structural epilepsy at the time of investigation or previously in their medical history.The mean age of the included patients was 7.1 years (range 0.08-22) at last consultation. Infarct localisation was predominantly unilateral (86%), left sided (58%) and affecting the middle cerebral artery (94%). Genetic thrombophilia was identified in 52% of the patients examined with genetic testing. More than half of the individuals had CP (52%), and 38.5% had a cognitive outcome below average. First seizures occurred in the neonatal period in 58% of patients and developed into drug-refractory epilepsy in 24.1%. Children with late-onset of epilepsy were twice as likely to develop drug-refractory epilepsy (52.4%). Discussion: Our study shows that patients with PIS and seizures as common sequela often also develop CP. Children with later onset of epilepsy have a worse outcome. Patients with seizure onset in the neonatal period and reccuring seizures have a good response to treatment. Therefore, early diagnosis, follow-up examination and adequate therapy are important. Most children need intensive physiotherapy and speech therapy; however, participation in life is usually age-appropriate.

Cerebral Palsy After Perinatal Arterial Ischemic Stroke

2008 ◽  
Vol 23 (3) ◽  
pp. 279-286 ◽  
Author(s):  
Meredith R. Golomb ◽  
Bhuwan P. Garg ◽  
Chandan Saha ◽  
Faouzi Azzouz ◽  
Linda S. Williams
Keyword(s):  
Cerebral Palsy ◽  
Ischemic Stroke ◽  
Arterial Ischemic Stroke ◽  
Perinatal Arterial Ischemic Stroke

scholarly journals Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke

2017 ◽  
Vol 75 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Octávio Marques Pontes-Neto ◽  
Pedro Cougo ◽  
Sheila Cristina Ouriques Martins ◽  
Daniel G. Abud ◽  
Raul G. Nogueira ◽  
...  
Keyword(s):  
Health Care ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Health Care Providers ◽  
Cerebrovascular Diseases ◽  
Discussion Forums ◽  
Care Providers ◽  
Web Based ◽  
Health Authorities ◽  
Public Health Authorities

ABSTRACT These guidelines are the result of a joint effort from writing groups of the Brazilian Stroke Society, the Scientific Department of Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Stroke Network and the Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Members from these groups participated in web-based discussion forums with predefined themes, followed by videoconference meetings in which controversies and position statements were discussed, leading to a consensus. This guidelines focuses on the implications of the recent clinical trials on endovascular therapy for acute ischemic stroke due to proximal arterial occlusions, and the final text aims to guide health care providers, health care managers and public health authorities in managing patients with this condition in Brazil.

Two Children With Both Arm Ischemia and Arterial Ischemic Stroke During the Perinatal Period

2011 ◽  
Vol 26 (12) ◽  
pp. 1548-1554 ◽  
Author(s):  
Marilyn J. McKasson ◽  
Meredith R. Golomb
Keyword(s):  
Ischemic Stroke ◽  
Methylenetetrahydrofolate Reductase ◽  
Delayed Diagnosis ◽  
Limb Ischemia ◽  
Perinatal Period ◽  
Resonance Imaging ◽  
Arterial Ischemic Stroke ◽  
Cerebral Magnetic Resonance Imaging ◽  
Ischemic Limb ◽  
Perinatal Arterial Ischemic Stroke

It is rare for both limb ischemia and arterial ischemic stroke to occur in the same child during the perinatal period. Two children who appear to have had perinatal emboli to both an arm and a middle cerebral artery territory are presented here. One child required amputation of the ischemic limb below the shoulder, and the other required skin grafts to the distal ischemic fingers. Each of these children later received cerebral magnetic resonance imaging for evaluation of developmental delay and was found to have what appeared to be old perinatal arterial ischemic stroke. Both children were homozygous for the methylenetetrahydrofolate reductase C677T gene variant. Eight other children with perinatal limb ischemia and stroke were found on literature review; several also had delayed diagnosis of perinatal stroke. This report examines the approach to diagnosis and treatment in each of these and makes suggestions for the similar cases in the future.

scholarly journals Hematologic Malignancies in Pregnancy: Management Guidelines From an International Consensus Meeting

2016 ◽  
Vol 34 (5) ◽  
pp. 501-508 ◽  
Author(s):  
Michael Lishner ◽  
Irit Avivi ◽  
Jane F. Apperley ◽  
Daan Dierickx ◽  
Andrew M. Evens ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Pregnancy Termination ◽  
Perinatal Period ◽  
Hematologic Malignancies ◽  
Consensus Meeting ◽  
Care Providers ◽  
International Consensus ◽  
Management Guidelines

Purpose The incidence of hematologic malignancies during pregnancy is 0.02%. However, this figure is increasing, as women delay conception until a later age. Systemic symptoms attributed to the development of a hematologic cancer may overlap with physiologic changes of pregnancy. A favorable prognosis is contingent upon early diagnosis and treatment. Therefore, a high index of suspicion is required by health care providers. Although timely, accurate diagnosis followed by appropriate staging is essential and should not be delayed due to pregnancy, management guidelines are lacking due to insufficient evidence-based research. Consequently, treatment is delayed, posing significant risks to maternal and fetal health, and potential pregnancy termination. This report provides guidelines for clinical management of hematologic cancers during the perinatal period, which were developed by a multidisciplinary team including an experienced hematologist/oncologist, a high-risk obstetrics specialist, a neonatologist, and experienced nurses, social workers, and psychologists. Methods These guidelines were developed by experts in the field during the first International Consensus Meeting of Prenatal Hematologic Malignancies, which took place in Leuven, Belgium, on May 23, 2014. Results and Conclusion This consensus summary equips health care professionals with novel diagnostic and treatment methodologies that aim for optimal treatment of the mother, while protecting fetal and pediatric health.

Prevention of Postpartum Psychopathology

2014 ◽  
Author(s):  
Golfo Tzilos ◽  
Kristina Davis ◽  
Caron Zlotnick
Keyword(s):  
Psychiatric Disorder ◽  
Health Care Providers ◽  
Illicit Drugs ◽  
Perinatal Period ◽  
Adverse Outcomes ◽  
Postpartum Women ◽  
Preventive Interventions ◽  
Care Providers ◽  
High Risk Women ◽  
Opportune Time

Approximately 26% of postpartum women meet diagnostic criteria for a psychiatric disorder. Untreated psychopathology in the postpartum period is associated with a range of adverse outcomes for both infant and mother. Fortunately, the perinatal period provides an opportune time to intervene with and prevent postpartum psychopathology. Women have increased contact with health care providers during this time, providing an avenue through which access to prevention can be improved. Furthermore, with increased knowledge to identify high-risk women, preventive interventions can be delivered to assist both the woman and infant. Preventive efforts for postpartum psychopathology are aimed at modifying risk factors or protective factors to prevent the psychiatric disorder and primarily use three distinct approaches: universal, selective, and indicated. This chapter provides a review of the empirical research in the prevention of postpartum psychopathologies including postpartum depression, anxiety, bipolar disorder, psychosis, and addictions (tobacco, alcohol, and illicit drugs).

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