Network injury to pulvinar with neonatal arterial ischemic stroke.
The purpose of this study is to establish that newborn stroke involving extensive parts of cerebral cortex immediately leads to secondary network injury in pulvinar. Seven term infants with cortical stroke presented with hypersignal in pulvinar on DWI. Stroke types included: complete MCA stroke (n=4); PCA stroke, ICA stroke and multiple artery stroke (1 each). Age range at scanning was between day 2 and 6 after birth (except for 1 infant scanned within 7 days of acute presentation during ECMO). ADC values in secondarily injured pulvinar were significantly higher than in the area with primary (sub)cortical injury (all patients scanned with identical MR image acquisition). In the absence of asphyxia and because pulvinar is outside of the primary area of infarction, we conclude that there are suggestions from imaging for acute secondary injury to pulvinar following primary damage of their cortical targets and/or connecting axons. Acute secondary injury is probably due to excitotoxicity and deafferentiation. The relevance of network injury for prognosis and the impact of early treatment on it have yet to be studied, in stroke but also in other acute perinatal brain disorders.
Govaert
Paul
P
Neonatal Intensive Care Unit, Sophia Children's Hospital Erasmus MC Rotterdam, dr Molewaterplein 60, Rotterdam, The Netherlands. paul.govaert3@pandora.be
Zingman
Alissa
A
Jung
Youn Hoa
YH
Dudink
Jeroen
J
Swarte
Renate
R
Zecic
Alexandra
A
Meersschaut
Valerie
V
van Engelen
Susanne
S
Lequin
Maarten
M
D002545:Brain Ischemia / Q000150:complications / Q000151:congenital* / Q000473:pathology*; D002540:Cerebral Cortex / Q000473:pathology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D009415:Nerve Net / Q000473:pathology*; D011379:Prognosis; D020521:Stroke / Q000151:congenital* / Q000209:etiology / Q000473:pathology*; D013788:Thalamus / Q000473:pathology