Perinatal arteriyel iskemik inme hastalarının değerlendirilmesi: Tek merkez deneyimi

Year 2020, Volume: 4 Issue: 10, 861 - 864, 01.10.2020

Ozan Koçak

https://doi.org/10.28982/josam.811728

Abstract

Amaç: Perinatal arteriyel iskemik strok (PAIS), unilateral serebral palsi (UCP), epilepsi ve nörogelişimsel bozukluklar gibi morbidite ve nörolojik hastalığın sık nedenlerinden biridir. Bu çalışmanın amacı, PAIS hastalarının klinik özelliklerini, risk faktörlerini ve uzun vadeli sonuçlarını belirlemektir.
Yöntemler: Bu retrospektif kohort çalışma, Ocak 2009-Eylül 2015 tarihleri arasında Çocuk Nörolojisi Bölümünde takip edilen 49 PAIS hastası ile yapılmıştır. Demografik özellikler, gebelik öyküsü, tanı yaşı, ilk klinik bulgu, beyin MRG bulguları, perinatal risk faktörlerini ve uzun vadeli sonuçları hasta dosyalarından toplandı.
Bulgular: Çalışma grubu yaş ortalaması 6,3 (4,5) yıl olan, 30 kadın ve 19 erkekten oluşmuştur. İkiz gebelik (%6,1), intrauterin büyüme geriliği (IUGR) (%8,2), perpartum asfiksi (%8,2) ve prezentasyon anormallikleri (%6,1) en sık görülen maternal / neonatal risk faktörleri idi. En yaygın protrombotik risk faktörleri ise MTHFR mutasyonları (%42,85) ve FVL mutasyonlarıydı (%16,32). Hastalardaki epilepsi oranı %73,3 olarak saptandı ve bu hastaların % 6,4'ünde dirençli epilepsi vardı. Tüm hastalar unilateral serebral palsi tanısı ile izleniyordu.
Sonuç: PAIS risk faktörleri ve bu risk faktörlerinin PAIS gelişimindeki rolleri tam olarak belirlenmemiştir. Bu çalışmaya göre, PAIS hastalarının çoğunda en az bir veya daha fazla maternal, neonatal veya protrombotik risk faktörü bulunmaktadır. Ve tüm hastalarda PAIS ile ilgili motor ve bilişsel bozukluk vardır. Bu hastalığın nedenlerini tam olarak aydınlatmak ve önleyici tedbirler geliştirebilmek için daha fazla vaka içeren çok merkezli prospektif çalışmalara ihtiyaç vardır.

Keywords

Perinatal, Yenidoğan, İskemik, İnme, Epilepsi

Supporting Institution

Destekleyen kurum bulunmamaktadır

Evaluation of perinatal arterial ischemic stroke patients: A single center experience

Abstract

Aim: Perinatal arterial ischemic stroke (PAIS) is the one of the frequent causes of morbidity and neurologic disability, such as unilateral cerebral palsy (UCP), epilepsy and neurodevelopmental deficiencies. The aim of this study is to determine the clinical characteristics, risk factors and long term outcomes of PAIS patients.
Methods: This retrospective cohort study was conducted with 49 PAIS patients who were followed up in the Pediatric Neurology Department between January 2009 and September 2015. Clinical data including demographic features, gestational history, age at diagnosis, initial clinical presentation, brain MRI features, perinatal risk factors and long-term outcome were collected from patient files.
Results: The study group comprised 30 females and 19 males with a mean age of 6.3 (4.5) years. Twin pregnancy (6.1%), intrauterine growth retardation (IUGR) (8.2%), peripartum asphyxia (8.2%) and presentation abnormality (6.1%) were the most common maternal / neonatal risk factors. The most common prothrombotic risk factors were MTHFR mutations (42.85%), followed by FVL mutations (16.32%). The epilepsy rate was 73.3%, 6.4% of which had refractory epilepsy. All patients had UCP.
Conclusions: Risk factors and their roles in development of PAIS have not been fully established. According to this study, most of the PAIS patients have at least one or more maternal, neonatal or prothrombotic risk factors, and all patients have motor and cognitive impairment related with PAIS. Multi-center prospective studies with more cases are needed to fully enlighten the causes of this disease and to develop preventive measures.

Keywords

perinatal, neonatal, ıschemic, stroke, epilepsy

References

• 1. Raju TN, Nelson KB, Ferriero D, Lynch JK; NICHD-NINDS Perinatal Stroke Workshop Participants. Ischemic perinatal stroke: summary of a workshop sponsored by the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke. Pediatrics. 2007 Sep;120(3):609-16. doi: 10.1542/peds.2007-0336. PMID: 17766535.
• 2. Lee J, Croen LA, Lindan C, Nash KB, Yoshida CK, Ferriero DM, Barkovich AJ, Wu YW. Predictors of outcome in perinatal arterial stroke: a population-based study. Ann Neurol. 2005 Aug;58(2):303-8. doi: 10.1002/ana.20557. PMID: 16010659.
• 3. Lynch JK, Hirtz DG, DeVeber G, Nelson KB. Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke. Pediatrics. 2002 Jan;109(1):116-23. doi: 10.1542/peds.109.1.116. PMID: 11773550.
• 4. Grinnon ST, Miller K, Marler JR, Lu Y, Stout A, Odenkirchen J, Kunitz S. National Institute of Neurological Disorders and Stroke Common Data Element Project - approach and methods. Clin Trials. 2012 Jun;9(3):322-9. doi: 10.1177/1740774512438980. Epub 2012 Feb 27. PMID: 22371630; PMCID: PMC3513359.
• 5. Kirton A, Deveber G, Pontigon AM, Macgregor D, Shroff M. Presumed perinatal ischemic stroke: vascular classification predicts outcomes. Ann Neurol. 2008 Apr;63(4):436-43. doi: 10.1002/ana.21334. PMID: 18306227.
• 6. Li C, Miao JK, Xu Y, Hua YY, Ma Q, Zhou LL, Liu HJ, Chen QX. Prenatal, perinatal and neonatal risk factors for perinatal arterial ischaemic stroke: a systematic review and meta-analysis. Eur J Neurol. 2017 Aug;24(8):1006-1015. doi: 10.1111/ene.13337. Epub 2017 Jun 24. PMID: 28646492.
• 7. Sorg AL, von Kries R, Klemme M, Gerstl L, Weinberger R, Beyerlein A, Lack N, Felderhoff-Müser U, Dzietko M. Risk factors for perinatal arterial ischaemic stroke: a large case-control study. Dev Med Child Neurol. 2020 Apr;62(4):513-520. doi: 10.1111/dmcn.14347. Epub 2019 Sep 5. PMID: 31489622.
• 8. Kocaman C, Yilmaz Y. Etiological analysis of presumed perinatal stroke. Brain Dev. 2012 Feb;34(2):133-9. doi: 10.1016/j.braindev.2011.04.003. Epub 2011 May 11. PMID: 21561729.
• 9. Simchen MJ, Goldstein G, Lubetsky A, Strauss T, Schiff E, Kenet G. Factor v Leiden and antiphospholipid antibodies in either mothers or infants increase the risk for perinatal arterial ischemic stroke. Stroke. 2009 Jan;40(1):65-70. doi: 10.1161/STROKEAHA.108.527283. Epub 2008 Oct 16. PMID: 18927445.
• 10. Fluss J, Garcia-Tarodo S, Granier M, Villega F, Ferey S, Husson B, Kossorotoff M, Muehlethaler V, Lebon S, Chabrier S. Perinatal arterial ischemic stroke related to carotid artery occlusion. Eur J Paediatr Neurol. 2016 Jul;20(4):639-48. doi: 10.1016/j.ejpn.2016.03.003. Epub 2016 Mar 16. PMID: 27025300.
• 11. Dunbar M, Kirton A. Perinatal Stroke. Semin Pediatr Neurol. 2019 Dec;32:100767. doi: 10.1016/j.spen.2019.08.003. Epub 2019 Aug 7. PMID: 31813521.
• 12. Lehman LL, Beaute J, Kapur K, Danehy AR, Bernson-Leung ME, Malkin H, Rivkin MJ, Trenor CC 3rd. Workup for Perinatal Stroke Does Not Predict Recurrence. Stroke. 2017 Aug;48(8):2078-2083. doi: 10.1161/STROKEAHA.117.017356. Epub 2017 Jul 13. PMID: 28706112.
• 13. Fluss J, Dinomais M, Chabrier S. Perinatal stroke syndromes: Similarities and diversities in aetiology, outcome and management. Eur J Paediatr Neurol. 2019 May;23(3):368-383. doi: 10.1016/j.ejpn.2019.02.013. Epub 2019 Feb 27. PMID: 30879961.
• 14. Govaert P. Sonographic stroke templates. Semin Fetal Neonatal Med. 2009 Oct;14(5):284-98. doi: 10.1016/j.siny.2009.07.006. Epub 2009 Aug 13. PMID: 19682961.
• 15. Gunny RS, Lin D. Imaging of perinatal stroke. Magn Reson Imaging Clin N Am. 2012 Feb;20(1):1-33. doi: 10.1016/j.mric.2011.10.001. PMID: 22118590.
• 16. Wu YW, March WM, Croen LA, Grether JK, Escobar GJ, Newman TB. Perinatal stroke in children with motor impairment: a population-based study. Pediatrics. 2004 Sep;114(3):612-9. doi: 10.1542/peds.2004-0385. PMID: 15342829.
• 17. Günther G, Junker R, Sträter R, Schobess R, Kurnik K, Heller C, Kosch A, Nowak-Göttl U; Childhood Stroke Study Group. Symptomatic ischemic stroke in full-term neonates : role of acquired and genetic prothrombotic risk factors. Stroke. 2000 Oct;31(10):2437-41. doi: 10.1161/01.str.31.10.2437. Erratum in: Stroke 2001 Jan;32(1):279. PMID: 11022077.
• 18. Curry CJ, Bhullar S, Holmes J, Delozier CD, Roeder ER, Hutchison HT. Risk factors for perinatal arterial stroke: a study of 60 mother-child pairs. Pediatr Neurol. 2007 Aug;37(2):99-107. doi: 10.1016/j.pediatrneurol.2007.04.007. PMID: 17675024.
• 19. Lee J, Croen LA, Backstrand KH, Yoshida CK, Henning LH, Lindan C, Ferriero DM, Fullerton HJ, Barkovich AJ, Wu YW. Maternal and infant characteristics associated with perinatal arterial stroke in the infant. JAMA. 2005 Feb 9;293(6):723-9. doi: 10.1001/jama.293.6.723. PMID: 15701914.
• 20. Chabrier S, Saliba E, Nguyen The Tich S, Charollais A, Varlet MN, Tardy B, Presles E, Renaud C, Allard D, Husson B, Landrieu P. Obstetrical and neonatal characteristics vary with birthweight in a cohort of 100 term newborns with symptomatic arterial ischemic stroke. Eur J Paediatr Neurol. 2010 May;14(3):206-13. doi: 10.1016/j.ejpn.2009.05.004. Epub 2009 Jun 21. PMID: 19541515.
• 21. Laugesaar R, Kolk A, Tomberg T, Metsvaht T, Lintrop M, Varendi H, Talvik T. Acutely and retrospectively diagnosed perinatal stroke: a population-based study. Stroke. 2007 Aug;38(8):2234-40. doi: 10.1161/STROKEAHA.107.483743. Epub 2007 Jun 21. PMID: 17585082.
• 22. Lee CC, Lin JJ, Lin KL, Lim WH, Hsu KH, Hsu JF, et al. Clinical Manifestations, Outcomes, and Etiologies of Perinatal Stroke in Taiwan: Comparisons between Ischemic, and Hemorrhagic Stroke Based on 10-year Experience in A Single Institute. Pediatr Neonatol. 2017 Jun;58(3):270-277. doi: 10.1016/j.pedneo.2016.07.005. Epub 2016 Nov 19. PMID: 28087259.
• 23. Nordstrand L, Eliasson AC, Holmefur M. Longitudinal development of hand function in children with unilateral spastic cerebral palsy aged 18 months to 12 years. Dev Med Child Neurol. 2016 Oct;58(10):1042-8. doi: 10.1111/dmcn.13106. Epub 2016 Mar 27. PMID: 27017925.
• 24. Bektaş G, Kipoğlu O, Pembegül Yıldız E, Aydınlı N, Çalışkan M, Özmen M, Sencer S. Epileptic spasm and other forms of epilepsy in presumed perinatal arterial ischemic stroke in Turkey after more than 10 years follow-up: A single centre study. Brain Dev. 2019 Sep;41(8):699-705. doi: 10.1016/j.braindev.2019.04.004. Epub 2019 Apr 16. PMID: 31003833.
• 25. Rattani A, Lim J, Mistry AM, Prablek MA, Roth SG, Jordan LC, Shannon CN, Naftel RP. Incidence of Epilepsy and Associated Risk Factors in Perinatal Ischemic Stroke Survivors. Pediatr Neurol. 2019 Jan;90:44-55. doi: 10.1016/j.pediatrneurol.2018.08.025. Epub 2018 Sep 21. PMID: 30409458.
• 26. Golomb MR, MacGregor DL, Domi T, Armstrong DC, McCrindle BW, Mayank S, deVeber GA. Presumed pre- or perinatal arterial ischemic stroke: risk factors and outcomes. Ann Neurol. 2001 Aug;50(2):163-8. doi: 10.1002/ana.1078. PMID: 11506398.
• 27. Wanigasinghe J, Reid SM, Mackay MT, Reddihough DS, Harvey AS, Freeman JL. Epilepsy in hemiplegic cerebral palsy due to perinatal arterial ischaemic stroke. Dev Med Child Neurol. 2010 Nov;52(11):1021-7. doi: 10.1111/j.1469-8749.2010.03699.x. PMID: 20497457.