Neurodevelopmental Outcome is Favorable in Neonatal Cerebral Stroke 1909

Abstract

Little information is available about neurodevelopmental outcome and associated risk factors in neonatal stroke. We are reviewing patients with neonatal stroke to correlate stroke characteristics with perinatal risk factors and long-term neurodevelopmental outcome. A cohort of patients from 1989-1991 were identifed from a radiology database. We collected data from inpatient and outpatient records on demographics, maternal risk factors, delivery, clinical presentation, laboratory, EEG and imaging studies. Infants were followed for a mean of 22 m (range 6 m-66 m) in a clinic where detailed neurologic and psychologic testing was performed. Of the 18 patients identified, 16 were full-term; the others were 33 and 36 weeks' gestation. No known risk factors were identified that would have predicted neonatal stroke. Five of 18 (27%) infants were delivered by emergency C/section and 8/18 (44%) had a 5 minute Apgar score <6. Seizures were the presentation in all cases, 38% occurring within 24h of birth and 69% within 72h. Strokes were bilateral in 8 (44%), left-sided in 6 (33%) and right-sided in 4 (22%). Two patients died, one had multiple congenital abnormalities and the other was taken off life-support on day 6. Stroke etiology was not determined in any case, but the evaluations were limited. Of the survivors, 11 (69%) were normal and 5 had cognitive and/or motor delays (4 moderate, 1 severe). Bayley exams were done on 9/16 patients of whom 2 had cognitive delay. Five patients had poor head growth on serial measurements. Of these, 4 had continued seizures and/or developmental impairment. One patient with moderate neurological delay and seizures had normal head growth. We conclude that stroke etiology should be investigated, outcome is generally good, and seizures beyond the neonatal period or poor head growth are associated with poor outcome.