Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Stroke. 2013 Aug;44(8):2115-20. doi: 10.1161/STROKEAHA.113.001064. Epub 2013 May 30.
To date, studies on neonatal stroke have mainly focused on cortical stroke. We have focused on perforator strokes, noncortical strokes in the arterial vascular perforator area. We sought to identify risk factors and evaluate clinical presentation and neuroimaging findings for neonatal perforator stroke, which seems to be under-recognized.
All infants admitted to our tertiary intensive care unit in ≈12 years, whose perforator stroke was diagnosed with postnatal brain imaging, were enrolled in this study. Demographic, perinatal, and postnatal data were evaluated.
Seventy-nine perforator strokes were detected in 55 patients (28 boys), with a median gestational age of 37 1/7 weeks (range 24 1/7 to 42 1/7 weeks, 25 preterm). Perforator stroke was asymptomatic in most patients (58%). Initial diagnosis was predominantly made with cranial ultrasound (80%) in the first week of life (60%). Risk factors for stroke were present in all cases: maternal, fetal, and perinatal. Likely pathogenic mechanisms were prolonged birth asphyxia (16%), hypoxia or hypotension (15%), embolism (15%), infection (15%), acute blood loss (9%), and birth trauma (9%).
Previously described risk factors for developing neonatal main artery stroke are probably also associated with neonatal perforator stroke. Perforator stroke is often asymptomatic, but cranial ultrasound is a reliable diagnostic tool in diagnosing perforator stroke.
迄今为止，关于新生儿脑卒中的研究主要集中在皮质性脑卒中。我们关注的是穿支性脑卒中，即穿支动脉区域的非皮质性脑卒中。我们旨在确定风险因素，并评估新生儿穿支性脑卒中的临床表现和神经影像学表现，因为这种脑卒中似乎尚未被充分认识。
本研究纳入了在约 12 年内入住我们的三级重症监护病房、并通过产后脑部影像学诊断为穿支性脑卒中的所有婴儿。评估了人口统计学、围产期和产后数据。
55 例患者（28 名男孩）中检测到 79 例穿支性脑卒中，中位胎龄为 37 1/7 周（范围 24 1/7 至 42 1/7 周，25 例为早产儿）。大多数患者（58%）的穿支性脑卒中无症状。最初的诊断主要是在生命的第一周通过头颅超声（80%）做出的（60%）。所有病例均存在脑卒中的风险因素：母体、胎儿和围产期。可能的发病机制为延长的出生窒息（16%）、缺氧或低血压（15%）、栓塞（15%）、感染（15%）、急性失血（9%）和产伤（9%）。
先前描述的发生新生儿主要动脉性脑卒中的风险因素可能也与新生儿穿支性脑卒中有关。穿支性脑卒中通常无症状，但头颅超声是诊断穿支性脑卒中的可靠诊断工具。
