Pediatric Clinics of North America - CIPERJ

PEDIATRIC ARTERIAL ISCHEMIC STROKE
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evidence has emerged recently with regard to prediction of outcomes in neonatal
AIS. An abnormal background on early neonatal encephalography
and an ischemia distribution that includes the internal capsule, basal ganglia,
and the surrounding cortex are associated with the development of
hemiplegia or asymmetry of tone without hemiplegia [67,68]. Acute findings
on MRI are predictive of hemiparesis in several series. The presence of signal
abnormalities in the posterior limb of the internal capsule or the cerebral
peduncles on magnetic resonance with diffusion-weighted imaging and ADC
mapping in neonatal acute AIS is associated with the development of unilateral
motor deficit [69,70]. Most recently, abnormal signal in the descending
corticospinal tract on magnetic resonance with diffusion-weighted imaging
in neonates who have AIS has been evaluated; the percentage of cerebral
peduncle affected and the total length of descending corticospinal tract
involved correlates with the development of hemiparesis [71].
Expressive speech impairments were noted in 12% of perinatal/neonatal
and 18% of non-neonatal AIS cases in a single study [53]. As for neuropsychologic
outcomes, cognitive or behavioral deficits were discerned in 3% to
14% of children who had neonatal AIS at an average follow-up of 2 to
6 years [68,72].
Despite important work to date in the field, prediction of outcomes and
risk stratification in neonatal and childhood stroke remain largely in their
infancy. Given the current limited knowledge of prognostic factors in pediatric
AIS, it is hoped that within the next few years, large multicenter cohort
analyses will permit further risk stratification, laying the foundation for
interventional clinical trials.
Acknowledgments
The authors thank Dr. Marilyn Manco-Johnson for helpful comments on
the manuscript and Dr. Laura Fenton for expert review of the radiologic
imaging studies presented in Figs. 1 and 2.
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