Lee Janet, Croen Lisa A, Lindan Camilla, Nash Kendall B, Yoshida Cathleen K, Ferriero Donna M, Barkovich A J, Wu Yvonne W
Department of Neurology, University of California, San Francisco, USA.
Ann Neurol. 2005 Aug;58(2):303-8. doi: 10.1002/ana.20557.
Some infants with perinatal arterial ischemic stroke (PAS) experience development of cerebral palsy (CP), epilepsy, and cognitive impairment, whereas others have a normal outcome. Previous prognostic studies rarely have included all diagnosed cases of PAS within a population. Among 199,176 infants born within Kaiser Permanente from 1997 to 2002, we electronically identified head imaging reports and physician diagnoses suggesting stroke. The diagnosis of PAS was confirmed by review of brain imaging and medical records. Presentation of PAS was considered delayed if symptoms were only noted after 28 days. Outcomes were determined by chart review. Of 40 infants with PAS, 36 were observed over 12 months. Abnormal outcomes included CP (58%), epilepsy (39%), language delay (25%), and behavioral abnormalities (22%). A delayed presentation was associated with increased risk for CP (relative risk [RR], 2.2; 95% confidence interval [CI], 1.2-4.2). Radiological predictors of CP included large stroke size (RR, 2.0; 95% CI, 1.2-3.2) and injury to Broca's area (RR, 2.5; 95% CI, 1.3-5.0), internal capsule (RR, 2.2; 95% CI, 1.1-4.4), Wernicke's area (RR, 2.0; 95% CI, 1.1-3.8), or basal ganglia (RR, 1.9; 95% CI, 1.1-3.3). Among infants with PAS, specific radiological findings and a lack of symptoms in the newborn period are associated with increased risk for CP.
一些围产期动脉缺血性卒中（PAS）患儿会出现脑瘫（CP）、癫痫和认知障碍，而其他患儿预后正常。以往的预后研究很少纳入人群中所有确诊的PAS病例。在1997年至2002年于凯撒医疗集团出生的199,176名婴儿中，我们通过电子方式识别出提示卒中的头部影像报告和医生诊断。通过回顾脑部影像和病历确诊PAS。如果症状仅在28天后才被发现，则认为PAS的表现为延迟性。通过查阅病历确定预后情况。在40例PAS患儿中，对36例进行了12个月的观察。不良预后包括CP（58%）、癫痫（39%）、语言发育迟缓（25%）和行为异常（22%）。延迟表现与CP风险增加相关（相对风险[RR]，2.2；95%置信区间[CI]，1.2 - 4.2）。CP的影像学预测因素包括大面积卒中（RR，2.0；95% CI，1.2 - 3.2）以及对布罗卡区（RR，2.5；95% CI，1.3 - 5.0）、内囊（RR，2.2；95% CI，1.1 - 4.4）、韦尼克区（RR，2.0；95% CI，1.1 - 3.8）或基底神经节（RR，1.9；95% CI，1.1 - 3.3）的损伤。在PAS患儿中，特定的影像学表现和新生儿期无症状与CP风险增加相关。
