Child's Nervous System ( IF 1.4 ) Pub Date : 2020-10-16 , DOI: 10.1007/s00381-020-04931-w Mauricio A López-Espejo 1 , Marta Hernández Chávez 1 , Isidro Huete 2
Purpose
The purpose of this study is to determine the frequency and radiological predictors of recurrent acute symptomatic seizures (RASS) and motor impairment at discharge after a neonatal arterial ischemic stroke (NAIS).
Methods
In a nonconcurrent cohort study, 33 full-term newborns with NAIS confirmed by MRI are admitted into our hospital between January 2003 and December 2012. Stroke size, calculated as stroke volume divided by whole brain volume (WBV), was categorized as > or < 3.3% of WBV. A univariate analysis of categorical variables was performed using Fisher’s exact test. A multivariate analysis was performed using logistic regression models including all variables with a p value < 0.1 in the univariate analysis.
Results
The median age at NAIS was 2 days (IQR, 1–5.6), 36.4% were girls. The stroke size was > 3.3 of WBV in 48.5% of the cases, and 54.5% showed multifocal lesions. Involvement of the cerebral cortex (54.5%), thalamus (48.5%), posterior limb of the internal capsule (36.4%), basal ganglia (36.4%), and brainstem (28.2%) were found. At discharge, 45.5% of newborns had a motor deficit, and 27.3% had at least two seizures. Multivariate analyses revealed that stroke size > 3.3% of WBV (OR: 8.1, CI: 1.2–53.9) and basal ganglia involvement (OR: 12.8, CI: 1.7–95.4) predicted motor impairment at discharge. Cortical involvement of temporal and frontal lobes (OR: 14, CI: 2.2–88.1; and OR: 9.1, CI: 1.2–72.6) were predictive of RASS.
Conclusion
Stroke size and location are independent risk factors for adverse short-term neurological outcomes in full-term newborns following a NAIS.
中文翻译:
新生儿动脉缺血性中风后的短期预后
目的
这项研究的目的是确定新生儿动脉缺血性卒中(NAIS)后复发的急性症状性癫痫发作(RASS)和运动障碍的频率和影像学预测指标。
方法
在一项非同期队列研究中,2003年1月至2012年12月之间,有33例经MRI证实为NAIS的足月新生儿入院。中风量,按中风量除以全脑量(WBV)计算,分为>或< WBV的3.3%。使用Fisher精确检验对分类变量进行单变量分析。使用logistic回归模型进行多变量分析,包括单变量分析中所有p值<0.1的变量。
结果
NAIS的中位年龄为2天(IQR,1-5.6),其中36.4%为女孩。在48.5%的病例中,卒中大小大于WBV的3.3,而54.5%的病例表现为多灶性病变。发现大脑皮层(54.5%),丘脑(48.5%),内囊后肢(36.4%),基底神经节(36.4%)和脑干(28.2%)受累。出院时,有45.5%的新生儿有运动障碍,而27.3%的新生儿至少有两次癫痫发作。多变量分析显示,卒中大小> WBV的3.3%(OR:8.1,CI:1.2-53.9)和基底神经节受累(OR:12.8,CI:1.7-95.4)可预测出院时运动障碍。颞叶和额叶的皮层受累(OR:14,CI:2.2-88.1; OR:9.1,CI:1.2-72.6)可预测RASS。
结论
脑卒中的大小和位置是NAIS后足月新生儿不良短期神经系统预后的独立危险因素。