title: Presumed pre- or perinatal arterial ischemic stroke: risk factors and outcomes.
abstract: A subgroup of children with arterial ischemic stroke in the pre- or perinatal period present with delayed diagnosis. We identified 22 children who met the following criteria: (1) normal neonatal neurological history, (2) hemiparesis and/or seizures first recognized after two months of age, and (3) computed tomography or magnetic resonance imaging showing remote cerebral infarct. Laboratory evaluations included protein C, protein S, antithrombin, activated protein C resistance screen (APCR), Factor V Leiden (FVL), prothrombin gene defect, methylene tetrahydrofolate reductase variant (MTHFR), anticardiolipin antibody (ACLA), and lupus anticoagulant. Not all children received all tests. Age at last visit ranged from 8 months to 16.5 years (median 4 years). Twelve were boys. Fourteen had left hemisphere infarcts. Median age at presentation was 6 months. Eighteen had gestational complications. Fourteen children had at least transient coagulation abnormalities (ACLA = 11, ACLA + APCR = 1, APCR = 2 with FVL + MTHFR = 1); six of these children had family histories suggestive of thrombosis. Cardiac echocardiogram was unremarkable in the 15 tested. Outcomes included persistent hemiparesis in 22; speech, behavior, or learning problems in 12; and persistent seizures in five, with no evidence of further stroke in any patient. The persistence and importance of coagulation abnormalities in this group need further study.
authors.affiliation: Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: M R
authors.initials: MR
authors.lastname: Golomb
authors.forename: D L
authors.initials: DL
authors.lastname: MacGregor
authors.forename: T
authors.initials: T
authors.lastname: Domi
authors.forename: D C
authors.initials: DC
authors.lastname: Armstrong
authors.forename: B W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: S
authors.initials: S
authors.lastname: Mayank
authors.forename: G A
authors.initials: GA
authors.lastname: deVeber
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002545:Brain Ischemia / Q000209:etiology* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D018743:Perinatal Care; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed