title: MR angiography findings in infants with neonatal arterial ischemic stroke in the middle cerebral artery territory: A prospective study using circle of Willis MR angiography.
abstract: OBJECTIVE
  Neonatal arterial ischemic stroke (NAIS) results from a focal disruption of the blood flow in a cerebral artery by a not well understood mechanism. Our objective is to describe the acute MRangiography (MRA) findings in infants with an NAIS in the middle cerebral artery (MCA) territory and correlate them with early parenchymal infarcts and motor outcome.
  
  
  METHODS
  Among one hundred prospectively followed neonates with NAIS, we studied thirty-seven patients with an MCA infarct explored with circle of Willis MRA. MCA flow characteristics were documented, along with infarct location/extent and motor outcome at age 7 years.
  
  
  RESULTS
  Twenty-three (62%) of the children showed arterial changes, all ipsilateral to the NAIS, with occlusion in six, thrombus-type flow defect in nine, and unilateral increased flow in enlarged insular arteries in the remaining eight. There was a statistically significant correlation between parenchymal and arterial MR findings (p=0.0002). A normal MRA had a negative predictive value of 100% (95% CI: 76.8-100) in ruling out a main branch infarct. Patients with abnormal MRA tended to be at increased risk for cerebral palsy (OR=3.1). Occlusion was associated with a worse outcome (p=0.04).
  
  
  CONCLUSIONS
  MRangiography shows arterial abnormalities suggesting that embolism is a frequent cause of NAIS.
authors.affiliation: AP-HP, Paediatric Radiology Dpt., French Centre for Paediatric Stroke, Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Husson
authors.affiliation: Paris Descartes University, INSERM U663, Paris-France/Neurospin, I2BM, DSV, CEA, Orsay, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Hertz-Pannier
authors.affiliation: Paris-Sud University, Faculty of Medicine, 63 rue Gabriel Péri/AP-HP, Pediatric Radiology Dpt, Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France. Electronic address: adamsbaum.catherine@gmail.com.
authors.forename: Catherine
authors.initials: C
authors.lastname: Adamsbaum
authors.affiliation: Department of Paediatric Physical Medicine and Rehabilitation, French Centre for Paediatric Stroke, St-Étienne Hospital, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Renaud
authors.affiliation: INSERM & University of Lyon/St Etienne, Dysfonction vasculaire et hémostase (DVA) Team, U1090 Sainbiose, St. Etienne, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Presles
authors.affiliation: LUNAM, Paediatric Physical Medicine and Rehabilitation Dpt, Angers Hospital, 49933 Angers, France, France.
authors.forename: Mickael
authors.initials: M
authors.lastname: Dinomais
authors.affiliation: Paris-Descartes University, Faculty of Medicine/AP-HP, French Centre for Paediatric Stroke, Paediatric Neurology Dpt., Necker-Enfants Malades Hospital, 149 rue de Sevres, 75015 Paris, France.
authors.forename: Manoelle
authors.initials: M
authors.lastname: Kossorotoff
authors.affiliation: AP-HP, Pediatric Neurology Dpt., Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Landrieu
authors.affiliation: Department of Paediatric Physical Medicine and Rehabilitation, French Centre for Paediatric Stroke, St-Étienne Hospital, France; INSERM & University of Lyon/St Etienne, Dysfonction vasculaire et hémostase (DVA) Team, U1090 Sainbiose, St. Etienne, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Chabrier
mesh_terms: D002648:Child; D002941:Circle of Willis / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008137:Longitudinal Studies; D018810:Magnetic Resonance Angiography; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies
keywords: Cerebral palsy; Magnetic resonance angiography; Magnetic resonance imaging; Neonatal stroke; Occlusion