Department of Pediatric Radiology, Public Assistance Hospital of Paris, CHU Bicêtre, 78 avenue du Général Leclerc, 94275 Le Kremlin-Bicêtre Cedex, France.
Pediatrics. 2010 Oct;126(4):912-8. doi: 10.1542/peds.2009-3611. Epub 2010 Sep 20.
We aimed to correlate early imaging data with motor outcomes in a large, homogeneous, cohort of infants with neonatal (diagnosed before 29 days of life) arterial ischemic stroke (AIS).
From a prospective cohort of 100 children with neonatal AIS, we analyzed the MRI studies performed within the 28 first days of life for 80 infants evaluated at 2 years of age. The relationships between infarction location and corticospinal tract (CST) involvement and motor outcomes were studied
Seventy-three infarctions involved the middle cerebral artery (MCA) territory. Of those, 50 were superficial infarctions, 5 deep infarctions, and 18 mixed infarctions. The CST was involved in 24 cases. Nineteen patients with MCA infarctions (26% [95% confidence interval: 16%-34%]) developed hemiplegia. Mixed infarctions (P<.0001) and CST involvement (P<.0001) were highly predictive of hemiplegia. In contrast, 88% of children with isolated superficial MCA infarctions did not exhibit impairment.
Accurate prediction of motor outcomes can be obtained from early MRI scans after neonatal AIS. The absence of involvement of the CST resulted in normal motor development in 94% of cases. CST involvement resulted in congenital hemiplegia in 66% of cases.
我们旨在通过对大量同质性新生儿动脉缺血性卒中（AIS）队列的早期影像学数据与运动结局进行相关性分析。
我们对 100 名新生儿 AIS 前瞻性队列中的 80 名婴儿进行了分析，这些婴儿在 2 岁时进行了 28 天内进行的 MRI 研究。研究了梗塞部位与皮质脊髓束（CST）受累之间的关系以及运动结局。
73 例梗塞涉及大脑中动脉（MCA）区域。其中，50 例为浅表性梗塞，5 例为深部梗塞，18 例为混合性梗塞。CST 受累 24 例。19 例 MCA 梗塞患者（26%[95%置信区间：16%-34%]）发生偏瘫。混合性梗塞（P<.0001）和 CST 受累（P<.0001）是偏瘫的高度预测因素。相比之下，88%孤立性浅表 MCA 梗塞的儿童未出现损伤。
新生儿 AIS 后早期 MRI 扫描可准确预测运动结局。CST 不受累可使 94%的病例运动发育正常。CST 受累导致先天性偏瘫的发生率为 66%。
