ARTICLE Neurodevelopment After Perinatal Arterial Ischemic Stroke Nienke Wagenaar, MD, a Miriam Martinez-Biarge, MD, b Niek E. van der Aa, MD, PhD, a Ingrid C. van Haastert, MA, PhD, a Floris Groenendaal, MD, PhD, a Manon J.N.L. Benders, MD, PhD, a Frances M. Cowan, MD, PhD, b Linda S. de Vries, MD, PhD a BACKGROUND AND OBJECTIVES: Perinatal arterial ischemic stroke (PAIS) leads to cerebral palsy in ∼30% of affected children and has other neurologic sequelae. Authors of most outcome studies focus on middle cerebral artery (MCA) stroke without differentiating between site and extent of affected tissue. Our aim with this study was to report outcomes after different PAIS subtypes. METHODS: Between 1990 and 2015, 188 term infants from 2 centers (London [n = 79] and Utrecht [n = 109]) had PAIS on their neonatal MRI. Scans were reevaluated to classify stroke territory and determine specific tissue involvement. At 18 to 93 (median 41.7) months, adverse neurodevelopmental outcomes were recorded as 1 or more of cerebral palsy, cognitive deficit, language delay, epilepsy, behavioral problems, or visual field defect. RESULTS: The MCA territory was most often involved (90%), with posterior or anterior cerebral artery territory strokes occurring in 9% and 1%, respectively. Three infants died, and 24 had scans unavailable for reevaluation or were lost to follow-up. Of 161 infants seen, 54% had an adverse outcome. Outcomes were the same between centers. Main branch MCA stroke resulted in 100% adverse outcome, whereas other stroke subtypes had adverse outcomes in only 29% to 57%. The most important outcome predictors were involvement of the corticospinal tracts and basal ganglia. CONCLUSIONS: Although neurodevelopmental outcome was adverse in at least 1 domain with main branch MCA stroke, in other PAIS subtypes outcome was favorable in 43% to 71% of children. Site and tissue involvement is most important in determining the outcome in PAIS. abstract a Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and b Department of Paediatrics, Imperial College London, London, United Kingdom Dr Wagenaar is the main author and drafted the manuscript, contributed to data acquisition and interpretation, and was responsible for communication with all coauthors; Drs Martinez-Biarge and van Haastert contributed to data acquisition and interpretation and revised the manuscript for intellectual content; Drs van der Aa, Groenendaal, and Benders contributed to the analysis and interpretation of the data and read the manuscript critically for intellectual content; Drs Cowan and de Vries contributed to the study design, coordination and supervision of data collection and analysis, and drafting and critically reviewing the manuscript; and all authors have seen and approved the final manuscript as submitted and take full responsibility for the manuscript. DOI: https://doi.org/10.1542/peds.2017-4164 Accepted for publication May 30, 2018 Address correspondence to Linda S. de Vries, MD, PhD, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, KE 04.123.1, PO Box 85090, 3508 AB Utrecht, Netherlands. E-mail: l.s.devries@umcutrecht.nl PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2018 by the American Academy of Pediatrics PEDIATRICS Volume 142, number 3, September 2018:e20174164 WHAT’S KNOWN ON THIS SUBJECT: Perinatal arterial ischemic stroke often leads to adverse neurodevelopmental outcomes. Authors of most outcome studies do not differentiate between site and extent of affected tissue in their association with neurodevelopmental outcome. WHAT THIS STUDY ADDS: With this study, we describe neurodevelopmental outcomes in different perinatal arterial ischemic stroke subtypes in a large and international cohort. Several MRI-based risk factors are provided that contribute to the prediction of neurodevelopmental outcomes in individual patients with perinatal stroke. To cite: Wagenaar N, Martinez-Biarge M, van der Aa NE, et al. Neurodevelopment After Perinatal Arterial Ischemic Stroke. Pediatrics. 2018;142(3):e20174164 by guest on June 6, 2020 www.aappublications.org/news Downloaded from