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

Öz

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.

Anahtar Kelimeler

• perinatal
• neonatal
• ıschemic
• stroke
• epilepsy

Perinatal arteriyel iskemik inme hastalarının değerlendirilmesi: Tek merkez deneyimi

Öz

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.

Anahtar Kelimeler

• Perinatal
• Yenidoğan
• İskemik
• İnme
• Epilepsi

Kaynakça

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