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.

中文翻译：

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围产期脑卒中患儿的头围轨迹

背景：

围产期中风是导致偏瘫脑瘫和终身残疾的主要原因。神经发育结果难以预测，长期不良结果的标志物仍在继续研究中。头围生长减速与新生儿脑损伤的发育结果较差有关。我们假设围产期中风会导致儿童期头部生长率下降，这与更糟糕的发育结果有关。

方法：

从基于人群的研究队列（阿尔伯塔围产期卒中项目）中确定了经磁共振成像 (MRI) 确诊的新生儿动脉缺血性卒中和动脉推测的围产期缺血性卒中的患者。从医疗记录中收集人口统计学和枕额周长数据。使用 2 尾t检验将头部生长与通常开发的控制图进行比较。Fisher 精确检验用于检查小儿卒中结果测量 (PSOM) 评分与枕额头围之间的关联。

结果：

从 102 名患者（48 名女性，54 名男性）中收集了 315 名枕额头围测量值，中位数为 3.2 年（标准差 = 5.18，范围 = 0-18.3）。女性患者 3 个月和男性患者 1 年后，枕额头围偏离并保持在正常生长轨迹以下（P < .05），效应量大（Cohen d >0.8）。不良结局（PSOM ≥ 1）与较小的枕额头围相关（P < .05）。

结论：

在围产期动脉缺血性卒中患儿中观察到头部生长减速，并且与不良结局相关。头围可能是提醒临床医生注意潜在的异常神经系统结果的工具。