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Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 2000 Jan;82(1):F59–F63. doi: 10.1136/fn.82.1.F59

Perinatal cortical infarction within middle cerebral artery trunks

P Govaert, E Matthys, A Zecic, F Roelens, A Oostra, B Vanzieleghem
PMCID: PMC1721024  PMID: 10634844

Abstract

AIM—To define neonatal pial middle cerebral artery infarction.
METHODS—A retrospective study was made of neonates in whom focal arterial infarction had been detected ultrasonographically. A detailed study was made of cortical middle cerebral artery infarction subtypes.
RESULTS—Forty infarctions, with the exception of those in a posterior cerebral artery, were detected ultrasonographically over a period of 10 years. Most were confirmed by computed tomography or magnetic resonance imaging. Factor V Leiden heterozygosity was documented in three. The onset was probably antepartum in three, and associated with fetal distress before labour in one. There were 19 cases of cortical middle cerebral artery stroke. The truncal type (n=13) was more common than complete (n = 5) middle cerebral artery infarction. Of six infarcts in the anterior trunk, four were in term infants and five affected the right hemisphere. Clinical seizures were part of the anterior truncal presentation in three. One of these infants, with involvement of the primary motor area, developed a severe motor hemisyndrome. The Bayley Mental Developmental Index was above 80 in all of three infants tested with anterior truncal infarction. Of seven patients with posterior truncal infarction, six were at or near term. Six of these lesions were left sided. Clinical seizures were observed in three. A mild motor hemisyndrome developed in at least three of these infants due to involvement of parieto-temporal non-primary cortex.
CONCLUSIONS—Inability to differentiate between truncal and complete middle cerebral artery stroke is one of the explanations for the reported different outcomes. Severe motor hemisyndrome can be predicted from neonatal ultrasonography on the basis of primary motor cortex involvement. Clinical seizures were recognised in less than half of the patients with truncal infarction; left sided presentation was present in the posterior, but not the anterior truncal type of infarction. Asphyxia is a rare cause of focal arterial infarction.



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Selected References

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  1. Allan W. C., Riviello J. J., Jr Perinatal cerebrovascular disease in the neonate. Parenchymal ischemic lesions in term and preterm infants. Pediatr Clin North Am. 1992 Aug;39(4):621–650. doi: 10.1016/s0031-3955(16)38368-7. [DOI] [PubMed] [Google Scholar]
  2. Baumann R. J., Carr W. A., Shuman R. M. Patterns of cerebral arterial injury in children with neurological disabilities. J Child Neurol. 1987 Oct;2(4):298–306. doi: 10.1177/088307388700200413. [DOI] [PubMed] [Google Scholar]
  3. Billard C., Dulac O., Diebler C. Ramollissement cérébral ischémique du nouveau-né. Une étiilogie possible des états de mal convulsifs néonatals. Arch Fr Pediatr. 1982 Nov;39(9):677–683. [PubMed] [Google Scholar]
  4. Bouza H., Dubowitz L. M., Rutherford M., Pennock J. M. Prediction of outcome in children with congenital hemiplegia: a magnetic resonance imaging study. Neuropediatrics. 1994 Apr;25(2):60–66. doi: 10.1055/s-2008-1071587. [DOI] [PubMed] [Google Scholar]
  5. Claeys V., Deonna T., Chrzanowski R. Congenital hemiparesis: the spectrum of lesions. A clinical and computerized tomographic study of 37 cases. Helv Paediatr Acta. 1983 Dec;38(5-6):439–455. [PubMed] [Google Scholar]
  6. Clancy R., Malin S., Laraque D., Baumgart S., Younkin D. Focal motor seizures heralding stroke in full-term neonates. Am J Dis Child. 1985 Jun;139(6):601–606. doi: 10.1001/archpedi.1985.02140080071035. [DOI] [PubMed] [Google Scholar]
  7. De Vries L. S., Regev R., Connell J. A., Bydder G. M., Dubowitz L. M. Localized cerebral infarction in the premature infant: an ultrasound diagnosis correlated with computed tomography and magnetic resonance imaging. Pediatrics. 1988 Jan;81(1):36–40. [PubMed] [Google Scholar]
  8. De Vries L. S., Smet M., Goemans N., Wilms G., Devlieger H., Casaer P. Unilateral thalamic haemorrhage in the pre-term and full-term newborn. Neuropediatrics. 1992 Jun;23(3):153–156. doi: 10.1055/s-2008-1071332. [DOI] [PubMed] [Google Scholar]
  9. Estan J., Hope P. Unilateral neonatal cerebral infarction in full term infants. Arch Dis Child Fetal Neonatal Ed. 1997 Mar;76(2):F88–F93. doi: 10.1136/fn.76.2.f88. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fujimoto S., Yokochi K., Togari H., Nishimura Y., Inukai K., Futamura M., Sobajima H., Suzuki S., Wada Y. Neonatal cerebral infarction: symptoms, CT findings and prognosis. Brain Dev. 1992 Jan;14(1):48–52. doi: 10.1016/s0387-7604(12)80279-8. [DOI] [PubMed] [Google Scholar]
  11. Giroud M., Fayolle H., Martin D., Baudoin N., André N., Gouyon J. B., Nivelon J. L., Dumas R. Late thalamic atrophy in infarction of the middle cerebral artery territory in neonates. A prospective clinical and radiological study in four children. Childs Nerv Syst. 1995 Mar;11(3):133–136. doi: 10.1007/BF00570252. [DOI] [PubMed] [Google Scholar]
  12. Gould R. J., Black K., Pavlakis S. G. Neonatal cerebral arterial thrombosis: protein C deficiency. J Child Neurol. 1996 May;11(3):250–252. doi: 10.1177/088307389601100320. [DOI] [PubMed] [Google Scholar]
  13. Groenendaal F., van der Grond J., Witkamp T. D., de Vries L. S. Proton magnetic resonance spectroscopic imaging in neonatal stroke. Neuropediatrics. 1995 Oct;26(5):243–248. doi: 10.1055/s-2007-979764. [DOI] [PubMed] [Google Scholar]
  14. Guajardo L., Strauss A., Amster J. Idiopathic cerebral infarction and upper limb ischemia in neonates. Am J Perinatol. 1994 Mar;11(2):119–122. doi: 10.1055/s-2007-994570. [DOI] [PubMed] [Google Scholar]
  15. Gudinchet F., Dreyer J. L., Payot M., Duvoisin B., Laurini R. Imaging of neonatal arterial thrombosis. Arch Dis Child. 1991 Oct;66(10 Spec No):1158–1159. doi: 10.1136/adc.66.10_spec_no.1158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hill A., Martin D. J., Daneman A., Fitz C. R. Focal ischemic cerebral injury in the newborn: diagnosis by ultrasound and correlation with computed tomographic scan. Pediatrics. 1983 May;71(5):790–793. [PubMed] [Google Scholar]
  17. Klesh K. W., Murphy T. F., Scher M. S., Buchanan D. E., Maxwell E. P., Guthrie R. D. Cerebral infarction in persistent pulmonary hypertension of the newborn. Am J Dis Child. 1987 Aug;141(8):852–857. doi: 10.1001/archpedi.1987.04460080038023. [DOI] [PubMed] [Google Scholar]
  18. Koelfen W., Freund M., König S., Varnholt V., Rohr H., Schultze C. Results of parenchymal and angiographic magnetic resonance imaging and neuropsychological testing of children after stroke as neonates. Eur J Pediatr. 1993 Dec;152(12):1030–1035. doi: 10.1007/BF01957231. [DOI] [PubMed] [Google Scholar]
  19. Koelfen W., Freund M., Varnholt V. Neonatal stroke involving the middle cerebral artery in term infants: clinical presentation, EEG and imaging studies, and outcome. Dev Med Child Neurol. 1995 Mar;37(3):204–212. doi: 10.1111/j.1469-8749.1995.tb11993.x. [DOI] [PubMed] [Google Scholar]
  20. Koelfen W., Wentz U., Freund M., Schultze C. Magnetic resonance angiography in 140 neuropediatric patients. Pediatr Neurol. 1995 Jan;12(1):31–38. doi: 10.1016/0887-8994(94)00096-k. [DOI] [PubMed] [Google Scholar]
  21. Kotlarek F., Rodewig R., Brüll D., Zeumer H. Computed tomographic findings in congenital hemiparesis in childhood and their relation to etiology and prognosis. Neuropediatrics. 1981 May;12(2):101–109. doi: 10.1055/s-2008-1059643. [DOI] [PubMed] [Google Scholar]
  22. Levy S. R., Abroms I. F., Marshall P. C., Rosquete E. E. Seizures and cerebral infarction in the full-term newborn. Ann Neurol. 1985 Apr;17(4):366–370. doi: 10.1002/ana.410170411. [DOI] [PubMed] [Google Scholar]
  23. Lien J. M., Towers C. V., Quilligan E. J., de Veciana M., Toohey J. S., Morgan M. A. Term early-onset neonatal seizures: obstetric characteristics, etiologic classifications, and perinatal care. Obstet Gynecol. 1995 Feb;85(2):163–169. doi: 10.1016/0029-7844(94)00375-N. [DOI] [PubMed] [Google Scholar]
  24. Maegaki Y., Maeoka Y., Ishii S., Shiota M., Takeuchi A., Yoshino K., Takeshita K. Mechanisms of central motor reorganization in pediatric hemiplegic patients. Neuropediatrics. 1997 Jun;28(3):168–174. doi: 10.1055/s-2007-973695. [DOI] [PubMed] [Google Scholar]
  25. Mannino F. L., Trauner D. A. Stroke in neonates. J Pediatr. 1983 Apr;102(4):605–610. doi: 10.1016/s0022-3476(83)80200-5. [DOI] [PubMed] [Google Scholar]
  26. Mantovani J. F., Gerber G. J. 'Idiopathic' neonatal cerebral infarction. Am J Dis Child. 1984 Apr;138(4):359–362. doi: 10.1001/archpedi.1984.02140420025010. [DOI] [PubMed] [Google Scholar]
  27. Molteni B., Oleari G., Fedrizzi E., Bracchi M. Relation between CT patterns, clinical findings and etiological factors in children born at term, affected by congenital hemiparesis. Neuropediatrics. 1987 May;18(2):75–80. doi: 10.1055/s-2008-1052456. [DOI] [PubMed] [Google Scholar]
  28. Perlman J. M., Rollins N. K., Evans D. Neonatal stroke: clinical characteristics and cerebral blood flow velocity measurements. Pediatr Neurol. 1994 Nov;11(4):281–284. doi: 10.1016/0887-8994(94)90002-7. [DOI] [PubMed] [Google Scholar]
  29. Raine J., Davies H., Gamsu H. R. Multiple idiopathic emboli in a full term neonate. Acta Paediatr Scand. 1989 Jul;78(4):644–646. doi: 10.1111/j.1651-2227.1989.tb17956.x. [DOI] [PubMed] [Google Scholar]
  30. Roodhooft A. M., Parizel P. M., Van Acker K. J., Deprettere A. J., Van Reempts P. J. Idiopathic cerebral arterial infarction with paucity of symptoms in the full-term neonate. Pediatrics. 1987 Sep;80(3):381–385. [PubMed] [Google Scholar]
  31. Smith C. D., Baumann R. J. Clinical features and magnetic resonance imaging in congenital and childhood stroke. J Child Neurol. 1991 Jul;6(3):263–272. doi: 10.1177/088307389100600311. [DOI] [PubMed] [Google Scholar]
  32. Sran S. K., Baumann R. J. Outcome of neonatal strokes. Am J Dis Child. 1988 Oct;142(10):1086–1088. doi: 10.1001/archpedi.1988.02150100080031. [DOI] [PubMed] [Google Scholar]
  33. Steventon D. M., John P. R. Power Doppler ultrasound appearances of neonatal ischaemic brain injury. Pediatr Radiol. 1997 Feb;27(2):147–149. doi: 10.1007/s002470050087. [DOI] [PubMed] [Google Scholar]
  34. Taylor G. A. Alterations in regional cerebral blood flow in neonatal stroke: preliminary findings with color Doppler sonography. Pediatr Radiol. 1994;24(2):111–115. doi: 10.1007/BF02020166. [DOI] [PubMed] [Google Scholar]
  35. Trauner D. A., Chase C., Walker P., Wulfeck B. Neurologic profiles of infants and children after perinatal stroke. Pediatr Neurol. 1993 Sep-Oct;9(5):383–386. doi: 10.1016/0887-8994(93)90107-n. [DOI] [PubMed] [Google Scholar]
  36. Trauner D. A., Mannino F. L. Neurodevelopmental outcome after neonatal cerebrovascular accident. J Pediatr. 1986 Mar;108(3):459–461. doi: 10.1016/s0022-3476(86)80897-6. [DOI] [PubMed] [Google Scholar]
  37. Wulfeck B. B., Trauner D. A., Tallal P. A. Neurologic, cognitive, and linguistic features of infants after early stroke. Pediatr Neurol. 1991 Jul-Aug;7(4):266–269. doi: 10.1016/0887-8994(91)90043-k. [DOI] [PubMed] [Google Scholar]
  38. de Vries L. S., Groenendaal F., Eken P., van Haastert I. C., Rademaker K. J., Meiners L. C. Infarcts in the vascular distribution of the middle cerebral artery in preterm and fullterm infants. Neuropediatrics. 1997 Apr;28(2):88–96. doi: 10.1055/s-2007-973679. [DOI] [PubMed] [Google Scholar]

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