Abstract
BackgroundPerinatal stroke (PS) is the leading cause of hemiparetic cerebral palsy (CP). Involvement of the corticospinal tract on neonatal magnetic resonance imaging (MRI) is predictive of motor outcome in patients with hemiparetic CP. However, early MRI is not available in patients with delayed presentation of PS and prediction of hemiparesis severity remains a challenge.AimsTo evaluate the volumes of the basal ganglia, amygdala, thalamus, and hippocampus following perinatal ischemic stroke in relation to hand motor function in children with a history of PS and to compare the volumes of subcortical structures in children with PS and in healthy controls.MethodsTerm born PS children with arterial ischemic stroke (AIS) (n = 16) and with periventricular venous infarction (PVI) (n = 18) were recruited from the Estonian Pediatric Stroke Database. MRI was accuired during childhood (4-18 years) and the volumes of the basal ganglia, thalamus, amygdala and hippocampus were calculated. The results of stroke patients were compared to the results of 42 age- and sex-matched healthy controls. Affected hand function was evaluated by Assisting Hand Assessment (AHA) and classified by the Manual Ability Classification System (MACS).ResultsCompared to the control group, children with AIS had smaller volumes of the ipsi- and contralesional thalami, ipsilesional globus pallidus, nucleus accumbens and hippocampus (p < 0.005). Affected hand function in children with AIS was correlated with smaller ipsilesional thalamus, putamen, globus pallidus, hippocampus, amygdala and contralesional amygdala (r > 0.5; p < 0.05) and larger volume of the contralesional putamen and hippocampus (r < − 0.5; p < 0.05).In children with PVI, size of the ipsilesional caudate nucleus, globus pallidus, thalamus (p ≤ 0.001) and hippocampus (p < 0.03) was smaller compared to controls. Smaller volume of the ipsi- and contralesional thalami and ipsilesional caudate nucleus was correlated with affected hand function (r > 0.55; p < 0.05) in children with PVI.ConclusionsSmaller volume of ipsilesional thalamus was associated with poor affected hand function regardless of the perinatal stroke subtype. The pattern of correlation between hand function and volume differences in the other subcortical structures varied between children with PVI and AIS. Evaluation of subcortical structures is important in predicting motor outcome following perinatal stroke.
Highlights
Perinatal stroke (PS) is an increasingly acknowledged cause of significant lifelong motor impairment, but causes combined neurocognitive morbidity [1,2,3]
Affected hand function in children with arterial ischemic stroke (AIS) was correlated with smaller ipsilesional thalamus, putamen, globus pallidus, hippocampus, amygdala and contralesional amygdala (r > 0.5; p < 0.05) and larger volume of the contralesional putamen and hippocampus (r < − 0.5; p < 0.05)
Smaller volume of ipsilesional thalamus was associated with poor affected hand function regardless of the perinatal stroke subtype
Summary
Perinatal stroke (PS) is an increasingly acknowledged cause of significant lifelong motor impairment, but causes combined neurocognitive morbidity [1,2,3]. Two vascular types of injury, arterial ischemic stroke (AIS) and periventricular venous infarction (PVI), predominate among PS syndromes [2, 5, 6]. Radiologic imaging shows chronic changes after stroke, which are presumed to occur during the pre- or perinatal period. Neonatal and presumed perinatal AIS are caused by large artery occlusions, usually in the middle cerebral artery (MCA) territory, with cortical and subcortical injuries, most often acquired near term birth. The established mechanism of PVI in preterm infants is germinal matrix hemorrhage before 34 weeks of gestation, leading to compression of the medullary veins and focal venous infarction of the periventricular white matter. Involvement of the corticospinal tract on neonatal magnetic resonance imaging (MRI) is predictive of motor outcome in patients with hemiparetic CP. Early MRI is not available in patients with delayed presentation of PS and prediction of hemiparesis severity remains a challenge
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