Abstract T P321: Perinatal Stroke in the Canadian Cerebral Palsy Registry: Disease-Controlled Risk Factor Analysis

Abstract

Objective: Perinatal stroke causes most hemiparetic cerebral palsy (CP). Pathophysiology is usually idiopathic with few case-control risk factor studies. Comparisons to related disease states have not been done in perinatal stroke and may provide unique insight. The Canadian CP registry (CCPR) is multi-regional and population-based with imaging results and >70 risk factor variables. We hypothesized that CCPR perinatal stroke could be defined with distinct risk factor profiles within CP populations. Methods: The CCPR enrolls children with CP across 13 Canadian centres. Systematic chart reviews and parental interviews acquire standardized data on >150 variables including risk factors and imaging. Data current to June 2013 was extracted (RedCAP) and analyzed (SPSS). Imaging reports for hemiparetic CP cases were classified as: (1) definitive stroke, (2) probable stroke, (3) not stroke (alternate diagnosis), or (4) inconclusive. Risk factor variables were compared between definitive stroke and two disease control groups: (1) hemiparetic CP, not stroke and (2) all other CP. Univariate analysis (Chi-Square, t-test) informed multivariate logistic regression (associations expressed as odds ratios, 95% confidence intervals). Results: At extraction, 1168 children were enrolled (57% male, median 42±23mos). Hemiparetic was the single most common CP phenotype (323, 28%). Definitive perinatal stroke was common (158, 49%) compared to definitively not stroke (109, 34%). Strokes were arterial (103, 66.6%) or venous (52,33.3%). Comparing stroke to non-stroke hemiparetic CP found seven univariate associations but none persisted on multivariate analysis. Comparing stroke to other CP types, the following factors were independently associated with stroke: preeclampsia (2.35;1.11-4.95;p=0.025), prematurity (0.165;0.093-0.293; p<0.001), maternal drug use (5.03;2.05-12.35;p<0.0001) and possibly male gender (1.47;0.997-2.19;p=0.058). Conclusions: Perinatal stroke can be examined within CP registries. Disease-specific risk factors may include previously (male gender) or inconsistently (preeclampsia) reported associations and novel factors (maternal drugs). Disease-controlled approaches may inform perinatal stroke pathogenesis.