title: Presumed perinatal ischemic stroke: vascular classification predicts outcomes.
abstract: OBJECTIVE
  Perinatal stroke commonly causes childhood neurological morbidity. Presumed perinatal ischemic stroke (PPIS) defines children presenting outside a normal perinatal period with chronic, focal infarction on neuroimaging. Infarcts are assumed to represent arterial strokes, but recent evidence suggests the periventricular venous infarction (PVI) of infants born preterm may also occur in utero and present as PPIS. Using the largest published cohort, we aimed to define arterial and PVI PPIS syndromes and their outcomes.
  
  
  METHODS
  A PPIS consecutive cohort was identified (SickKids Children's Stroke Program, 1992-2006). Systematic neuroradiological scoring executed by blinded investigators included previously defined arterial stroke syndromes. PVI criteria included unilateral injury with at least four of the following conditions: (1) focal periventricular encephalomalacia, (2) internal capsule T2 prolongation, (3) cortical and (4) relative basal ganglia sparing, and (5) remote hemorrhage. Arterial and PVI classifications were validated and correlated with neurological outcomes (Pediatric Stroke Outcome Measure).
  
  
  RESULTS
  In 59 PPISs (64% male), 94% of lesions fell within potential middle cerebral artery territories. Although arterial proximal M1 infarction was most common (n = 19; 35%), venous PVI was second (n = 12; 22%) and accounted for 75% of subcortical injuries. Motor outcomes (mean follow-up, 5.3 years) were predicted by basal ganglia involvement including leg hemiparesis, spasticity, and need for assistive devices (p < 0.01). Nonmotor outcomes were associated with cortical involvement, including cognitive/behavioral outcomes, visual deficits, and epilepsy (p < 0.01). Classification interrater reliability was excellent (correlation coefficients > 0.975).
  
  
  CONCLUSIONS
  Recognizable PPIS patterns predict long-term morbidity and may guide surveillance, therapy, and counseling. PVI is an underrecognized cause of PPIS and congenital hemiplegia.
authors.affiliation: Division of Neurology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada. adam.kirton@calgaryhealthregion.ca
authors.forename: Adam
authors.initials: A
authors.lastname: Kirton
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Deveber
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Pontigon
authors.forename: Daune
authors.initials: D
authors.lastname: Macgregor
authors.forename: Manohar
authors.initials: M
authors.lastname: Shroff
mesh_terms: D002545:Brain Ischemia / Q000145:classification* / Q000150:complications / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010291:Paresis / Q000145:classification / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D011237:Predictive Value of Tests; D021122:Protein Subunits; D012042:Registries; D020521:Stroke / Q000145:classification* / Q000150:complications / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D021122:Protein Subunits