Cerebral Palsy After Perinatal Arterial Ischemic Stroke

Abstract

The frequency of cerebral palsy, degree of disability, and predictors of disability were assessed in children in a perinatal arterial stroke database. Risk factors were assessed at the univariate level using the Pearson χ² and Fisher exact test and at the multivariate level using logistic regression analysis. Seventy-six of 111 children with perinatal stroke (68%) had cerebral palsy, most commonly hemiplegic (66/76; 87%). Multivariate analysis of the entire cohort showed both delayed presentation (OR,9.96; 95% CI, 3.10-32.02) and male sex (OR, 2.55; 95% CI, 1.03-6.32) were associated with cerebral palsy. In subgroup multivariate analyses: in children with neonatal presentation, bilateral infarcts were associated with triplegia or quadriplegia (OR, 5.33; 95% CI, 1.28-22.27); in children with unilateral middle cerebral artery infarcts, delayed presentation (OR, 10.60; 95% CI, 2.28-72.92) and large-branch infarction (OR, 8.78; 95% CI, 2.18-43.67) were associated with cerebral palsy. These data will aid physicians in planning long-term rehabilitative care for children with perinatal stroke.

Keywords

cerebral palsy outcomes perinatal arterial ischemic stroke

Get full access to this article

View all access options for this article.

References

Anderson KN , Anderson LE Mosby's pocket dictionary of medicine, nursing, and allied health. St Louis, MO: The C.V. Mosby Company; 1990.

Golomb MR , MacGregor DL , Domi T. , et al. Presumed pre- and perinatal stroke: risk factors and outcomes . Ann Neurol. 2001; 50:163-168.

Lee J. , Croen LA , Lindan C. , et al. Predictors of outcome in perinatal arterial stroke: a population-based study. Ann Neurol. 2005;58:303-308.

Friel JP Dorland's Illustrated Medical Dictionary. 26th ed. Philadelphia, PA: W.B. Saunders Company ; 1974.

National Institutes of Health NINDS Cerebral palsy information page. http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm. Published 2007. Accessed 2007.

Clancy R. , Malin S. , Laraque D. , Baumgart S. , Younkin D. Focal motor seizures heralding stroke in full-term neonates. Am J Dis Child. 1985;139:601-606.

Sran SK , Baumann RJ Outcome of neonatal strokes. Am J Dis Child. 1988;142:1086-1088.

Sreenan C. , Bhargava R. , Robertson CM Cerebral infarction in the term newborn: clinical presentation and long-term outcome. J Pediatr. 2000;137:351-355.

Trauner DA , Chase C. , Walker P. , Wulfeck B. Neurologic profiles of infants and children after perinatal stroke. Pediatr Neurol. 1993;9:383-386.

10.

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; 37:204-212.

11.

de Vries LS , Groenendaal F. , Eken P. , van Haastert IC , Rademaker KJ , Meiners LC Infarcts in the vascular distribution of the middle cerebral artery in preterm and fullterm infants. Neuropediatrics . 1997;28:88-96.

12.

Mercuri E. , Rutherford M. , Cowan F. , et al. Early prognostic indicators of outcome in infants with neonatal cerebral infarction: a clinical, electroencephalogram, and magnetic resonance imaging study. Pediatrics. 1999;103:39-46.

13.

deVeber GA , MacGregor D. , Curtis R. , Mayank S. Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol. 2000 ;15:316-324.

14.

Golomb MR , deVeber GA , MacGregor DL , et al. Independent walking after neonatal arterial ischemic stroke and sinovenous thrombosis. J Child Neurol. 2003;18:530-536.

15.

Golomb MR , Dick PT , MacGregor DL , Curtis R. , Sofronas M. , deVeber GA Neonatal arterial ischemic stroke and cerebral sinovenous thrombosis are more commonly diagnosed in boys. J Child Neurol. 2004;19:493-497.

16.

Jarvis S. , Glinianaia SV , Arnaud C. , et al. Case gender and severity in cerebral palsy varies with intrauterine growth. Arch Dis Child. 2005;90:474-479.

17.

Murphy CC , Yeargin-Allsopp M. , Decoufle P. , Drews CD Prevalence of cerebral palsy among ten-year-old children in metropolitan Atlanta, 1985 through 1987. J Pediatr. 1993; 123:S13-S20.

18.

Hintz SR , Kendrick DE , Vohr BR , Kenneth Poole W. , Higgins RD For The National Institute of Child Health and Human Development (NICHD) Neonatal Research Network. Gender differences in neurodevelopmental outcomes among extremely preterm, extremely-low-birthweight infants. Acta Paediatr. 2006; 95:1239-1248.

19.

Shankaran S. , Johnson Y. , Langer JC , et al. Outcome of extremely-low-birth-weight infants at highest risk: gestational age < or =24 weeks, birth weight < or =750 g, and 1-minute Apgar < or =3. Am J Obstet Gynecol. 2004 ; 191:1084-1091.

20.

Lee J. , Croen LA , Backstrand KH , et al. Maternal and infant characteristics associated with perinatal arterial stroke in the infant. JAMA. 2005;293:723-729.

21.

Scheller JM , Nelson KB Does cesarean delivery prevent cerebral palsy or other neurologic problems of childhood? Obstet Gynecol . 1994;83:624-630.

22.

Golomb MR , Garg BP , Saha C. , Williams LS Accuracy and yield of ICD-9 codes for identifying children with ischemic stroke . Neurology. 2006;67:2053-2055.