Presumed pre- or perinatal arterial ischemic stroke: Risk factors and outcomes

Meredith R. Golomb, Daune L. MacGregor, Trish Domi, Derek C. Armstrong, Brian W. McCrindle, Supriya Mayank, Gabrielle A. Deveber

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216 Scopus citations

Abstract

A subgroup of children with arterial ischemic stroke in the pre- or perinatal period present with delayed diagnosis. We identified 22 children who met the following criteria: (1) normal neonatal neurological history, (2) hemiparesis and/or seizures first recognized after two months of age, and (3) computed tomography or magnetic resonance imaging showing remote cerebral infarct. Laboratory evaluations included protein C, protein S, antithrombin, activated protein C resistance screen (APCR), Factor V Leiden (FVL), prothrombin gene defect, methylene tetrahydrofolate reductase variant (MTHFR), anticardiolipin antibody (ACLA), and lupus anticoagulant. Not all children received all tests. Age at last visit ranged from 8 months to 16.5 years (median 4 years). Twelve were boys. Fourteen had left hemisphere infarcts. Median age at presentation was 6 months. Eighteen had gestational complications. Fourteen children had at least transient coagulation abnormalities (ACLA = 11, ACLA + APCR = 1, APCR = 2 with FVL + MTHFR = 1); six of these children had family histories suggestive of thrombosis. Cardiac echocardiogram was unremarkable in the 15 tested. Outcomes included persistent hemiparesis in 22; speech, behavior, or learning problems in 12; and persistent seizures in five, with no evidence of further stroke in any patient. The persistence and importance of coagulation abnormalities in this group need further study.

Original languageEnglish (US)
Pages (from-to)163-168
Number of pages6
JournalAnnals of Neurology
Volume50
Issue number2
DOIs
StatePublished - Aug 22 2001

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ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Golomb, M. R., MacGregor, D. L., Domi, T., Armstrong, D. C., McCrindle, B. W., Mayank, S., & Deveber, G. A. (2001). Presumed pre- or perinatal arterial ischemic stroke: Risk factors and outcomes. Annals of Neurology, 50(2), 163-168. https://doi.org/10.1002/ana.1078