engleski

Longterm outcome of children with perinatal stroke

The aim of this study is to investigate the longterm outcome in 35 children with perinatal ischaemic stroke. The etiology, diagnosis, size, hemispheral localisation and vascular distribution of the lesions, as well as neurodevelopmental otucome were analysed. Four preterm and thirty-one full-term infants with perinatal ischaemic stroke were studied. Using brain Ultrasonography and Transcranial Color Doppler, focal ischaemic lesions were detected during infancy and confirmed by Computed Tomography and Magnetic Resonance Imaging with Angiography, later. Neurological assesment atfer 5 years of age, disclosed the presence od cerebral palsy, visual, hearing and speech disabillities, epileptic seizures and cognitive impairment. Due to diagnostic procedure, brain lesions were divided into three categories: according to the size of the lesion, hemispheral localisation and vascular distribution of the lesion The most of children had large brain lesions in irrigational area of middle cerebral artery (MCA), more frequent on the left side, but this is not statistically significant. The most frequent sequellae at the age of 5, was neuromotor impairment, which was detected in 33/35 children. Cerebral palsy (CP) was present in 29/35 children: unilateral spastic CP in 15/35 (43%) children, bilateral spastic CP in 6/35 (17%) and dystone-dyskinetic CP in 8/35 children (23%). The second sequellae was visual impairment, present in 31 children, and third one was speech impairment, present in 26 children. Epileptic seizures had 19 children, with 11 of them in neonatal period, too. Cognitive impairment was present in 19 children (46%). Neurodevelopmental outcome at the age of 5, did not depend on hemispheral localisation, nor the size of the lesion but is strongly related to vascular distribution of the lesion. Involvement of the main branch and lenticulostriatal branches of MCA caused poor neurodevelopmental outcome, as well as marginal zone lesions between MCA and anterior cerebral artery (ACA). Involvement of cortical branches of MCA caused mildly delayed neurodevelopmental outcome. Normal neurodevelopmental outcome was present only in children with involvement of posterior cerebral artery (PCA). Conclusion: Vascular distribution of the ischaemic lesion, detected by brain Ultrasonography and Transcranial Color Doppler Imaging, is better related to neurodevelopmental outcome in children with perinatal ischaemic stroke, compared to the size of the lesion and hemispheral distribution.

perinatal stroke; neurodevelopmental outcome

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