Sonographic templates of newborn perforator stroke.
BACKGROUND
Many paediatric strokes occur in the perinatal period. Improvement in neuroimaging has increased detection in newborns with neurological symptoms.


OBJECTIVE
To define sonographic templates of neonatal stroke in the territory of perforators of the anterior choroidal artery (AChA) and the anterior (ACA), middle (MCA) and posterior (PCA) cerebral arteries.


METHODS
In 24 neonates with perforator stroke, we retrospectively studied antenatal and perinatal events. Brain sonography was performed with an 8.5-MHz probe. Only hyperechoic lesions in the thalamus and/or striatum and/or centrum semiovale were included. MRI was obtained using a 1.5-T machine.


RESULTS
We detected 28 perforator strokes in 24 infants (6 preterm): 5 MCA medial striate, 8 MCA lateral striate, 3 MCA centrum semiovale, 4 ACA Heubner's, 5 PCA thalamic arteries, 1 AChA, and 2 hypothalamic perforators. We attributed clinical seizures to stroke in two infants only. Catheter-related embolism (certain in three, possible in six others) and birth trauma (two) were probable causes. Specific conditions were found in six others. Only one infant (in nine evaluated) had an increased prothrombotic risk (fII mutation). In describing the lesions, we focused on the templates of infarction as seen in a parasagittal US sweep. Infarcts were confirmed by MRI in 21 patients.


CONCLUSIONS
Our study showed that infarct topography can be evaluated reliably with brain sonography. This is important given the asymptomatic character of most lesions.
Abels
Lyanne
L
Department of Neonatology, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. w.abels@erasmusmc.nl
Lequin
Maarten
M
Govaert
Paul
P
D001921:Brain / Q000098:blood supply; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology; D014463:Ultrasonography