Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.
Department of Pediatrics and Clinical Neurosciences, Alberta Children's Hospital, Calgary, Alberta, Canada.
J Child Neurol. 2021 Jul;36(8):680-685. doi: 10.1177/0883073821996103. Epub 2021 Mar 8.
Perinatal stroke is a leading cause of hemiparetic cerebral palsy and lifelong disability. Neurodevelopmental outcomes are difficult to predict and markers of long-term poor outcome continue to be investigated. Deceleration in growth of head circumference has been associated with worse developmental outcomes in neonatal brain injury. We hypothesized that perinatal stroke would result in decreased rates of head growth during childhood that would be associated with worse developmental outcomes.
Patients with magnetic resonance imaging (MRI)-confirmed neonatal arterial ischemic stroke and arterial presumed perinatal ischemic stroke were identified from a population-based research cohort (Alberta Perinatal Stroke Project). Demographics and occipital-frontal circumference data were collected from medical records. Head growth was compared to typically developing control charts using a 2-tailed test. The Fisher exact test was used to examine associations between Pediatric Stroke Outcome Measures (PSOM) scores and occipital-frontal head circumference.
Three hundred fifteen occipital-frontal head circumference measurements were collected from 102 patients (48 female, 54 male), over a median of 3.2 years (standard deviation = 5.18, range = 0-18.3). After 3 months for female patients and 1 year for male patients, occipital-frontal head circumference deviated and remained below normal growth trajectories ( < .05) with a large effect size (Cohen >0.8). Poor outcome (PSOM ≥ 1) was associated with smaller occipital-frontal head circumference ( < .05).
Head growth deceleration is observed in children with perinatal arterial ischemic stroke and is associated with poor outcome. Head circumference may be a tool to alert clinicians to the potential of abnormal neurologic outcome.
围产期卒中是导致偏瘫性脑瘫和终身残疾的主要原因。神经发育结果难以预测，长期预后不良的标志物仍在研究中。头围生长减速与新生儿脑损伤的发育结果较差相关。我们假设围产期卒中将导致儿童期头围生长速度减慢，这将与较差的发育结果相关。
从基于人群的研究队列（阿尔伯塔围产期卒中项目）中确定了经磁共振成像（MRI）证实的新生儿动脉缺血性卒中患者和动脉性推测围产期缺血性卒中患者。从病历中收集人口统计学和枕额周长数据。使用双侧 t 检验将头围生长与正常发育对照图表进行比较。使用 Fisher 确切检验检查儿科卒中结局测量（PSOM）评分与枕额头围之间的关联。
从 102 例患者（48 例女性，54 例男性）中收集了 315 个头围测量值，中位数为 3.2 年（标准差=5.18，范围=0-18.3）。女性患者在 3 个月后，男性患者在 1 年后，枕额头围偏离并持续低于正常生长轨迹（<0.05），具有较大的效应量（Cohen>0.8）。不良结局（PSOM≥1）与较小的枕额头围相关（<0.05）。
在患有围产期动脉缺血性卒中的儿童中观察到头围生长减速，并且与不良结局相关。头围可能是一种工具，可以提醒临床医生注意异常神经结局的可能性。
