Presumed pre- or perinatal arterial ischemic stroke: Risk factors and outcomes
Article first published online: 18 JUN 2001
Copyright © 2001 Wiley-Liss, Inc.
Annals of Neurology
Volume 50, Issue 2, pages 163–168, August 2001
How to Cite
Golomb, M. R., MacGregor, D. L., Domi, T., Armstrong, D. C., McCrindle, B. W., Mayank, S. and DeVeber, G. A. (2001), Presumed pre- or perinatal arterial ischemic stroke: Risk factors and outcomes. Ann Neurol., 50: 163–168. doi: 10.1002/ana.1078
- Issue published online: 30 JUL 2001
- Article first published online: 18 JUN 2001
- Manuscript Accepted: 13 MAR 2001
- Manuscript Revised: 7 MAR 2001
- Manuscript Received: 25 OCT 2000
- Bloorview Children's Hospital Foundation
- Ontario Federation for Cerebral Palsy
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 2 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); 6 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 5, with no evidence of further stroke in any patient. The persistence and importance of coagulation abnormalities in this group need further study.