Motor outcomes after neonatal arterial ischemic stroke related to early MRI data in a prospective study.
OBJECTIVE
We aimed to correlate early imaging data with motor outcomes in a large, homogeneous, cohort of infants with neonatal (diagnosed before 29 days of life) arterial ischemic stroke (AIS).


METHODS
From a prospective cohort of 100 children with neonatal AIS, we analyzed the MRI studies performed within the 28 first days of life for 80 infants evaluated at 2 years of age. The relationships between infarction location and corticospinal tract (CST) involvement and motor outcomes were studied


RESULTS
Seventy-three infarctions involved the middle cerebral artery (MCA) territory. Of those, 50 were superficial infarctions, 5 deep infarctions, and 18 mixed infarctions. The CST was involved in 24 cases. Nineteen patients with MCA infarctions (26% [95% confidence interval: 16%-34%]) developed hemiplegia. Mixed infarctions (P<.0001) and CST involvement (P<.0001) were highly predictive of hemiplegia. In contrast, 88% of children with isolated superficial MCA infarctions did not exhibit impairment.


CONCLUSIONS
Accurate prediction of motor outcomes can be obtained from early MRI scans after neonatal AIS. The absence of involvement of the CST resulted in normal motor development in 94% of cases. CST involvement resulted in congenital hemiplegia in 66% of cases.
Husson
Béatrice
B
Department of Pediatric Radiology, Public Assistance Hospital of Paris, CHU Bicêtre, 78 avenue du Général Leclerc, 94275 Le Kremlin-Bicêtre Cedex, France. beatrice.husson@bct.aphp.fr
Hertz-Pannier
Lucie
L
Renaud
Cyrille
C
Allard
Dominique
D
Presles
Emilie
E
Landrieu
Pierre
P
Chabrier
Stéphane
S
D002544:Cerebral Infarction / Q000150:complications / Q000175:diagnosis; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging; D006429:Hemiplegia / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D020244:Infarction, Middle Cerebral Artery / Q000150:complications; D008279:Magnetic Resonance Imaging; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications* / Q000175:diagnosis