Govaert Paul
Sophia Children's Hospital Erasmus MC Rotterdam, dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
Semin Fetal Neonatal Med. 2009 Oct;14(5):250-66. doi: 10.1016/j.siny.2009.07.008. Epub 2009 Aug 6.
The main focus of this chapter is the comprehensive description of the neuropathology, the imaging correlates and underlying mechanisms of prenatal stroke. We describe established prenatal stroke in subgroups similar to postnatal stroke: arterial (forebrain or hindbrain) infarction, venous thrombosis, primary lobar haemorrhage. This longitudinal classification should facilitate the study of risk factors and mechanisms. Forebrain lesions of arterial type present as porencephaly, (hemi)hydranencephaly, multicystic encephalopathy or schizencephaly. Venous prenatal forebrain stroke presents as simple porencephaly (in some of genetic nature) and sinus thrombosis. A list of rare porencephaly-like conditions is added for differentiation from arterial and venous porencephaly. Hindbrain infarctions (so far the only reported variants seem to be of arterial nature) present as brainstem disconnection, focal brainstem destruction, uni- or bilateral cerebellar destruction and focal spinal cord ischaemia. Prenatal intracranial haemorrhage and congenital brain infection should be considered in the differential diagnosis of prenatal stroke.
本章的主要重点是对产前卒中的神经病理学、影像学关联及潜在机制进行全面描述。我们将已确诊的产前卒中按类似于产后卒中的亚组进行描述：动脉性（前脑或后脑）梗死、静脉血栓形成、原发性脑叶出血。这种纵向分类应有助于对危险因素和机制的研究。动脉型前脑病变表现为孔洞脑、（半）积水性无脑、多囊性脑病或脑裂畸形。产前静脉性前脑卒中表现为单纯孔洞脑（部分具有遗传性质）和静脉窦血栓形成。增加了一份罕见的类孔洞脑疾病清单，以与动脉性和静脉性孔洞脑相鉴别。后脑梗死（目前报告的唯一变体似乎为动脉性质）表现为脑干离断、局灶性脑干破坏、单侧或双侧小脑破坏以及局灶性脊髓缺血。产前颅内出血和先天性脑部感染应纳入产前卒中的鉴别诊断。
