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

被引:192
作者
Golomb, MR
MacGregor, DL
Domi, T
Armstrong, DC
McCrindle, BW
Mayank, S
deVeber, GA
机构
[1] Hosp Sick Children, Div Neurol, Toronto, ON M5G 1X8, Canada
[2] Hosp Sick Children, Dept Diagnost Imaging, Div Neuroradiol, Toronto, ON M5G 1X8, Canada
[3] Hosp Sick Children, Dept Pediat, Div Cardiol, Toronto, ON M5G 1X8, Canada
关键词
D O I
10.1002/ana.1078
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
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页码:163 / 168
页数:6
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