Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, 45-1, 7-chome, Nanakuma Jonan-ku, Fukuoka 814-0180, Japan.
Department of Pediatrics, Faculty of Medicine, Fukuoka University, 45-1, 7-chome, Nanakuma Jonan-ku, Fukuoka 814-0180, Japan.
Brain Dev. 2022 Nov;44(10):672-680. doi: 10.1016/j.braindev.2022.08.005. Epub 2022 Sep 2.
Neonatal arterial ischemic stroke (NAIS) presents as seizures, including convulsions, subtle seizures, and apnea, and most patients experience neurological sequelae. Diagnosis is often delayed owing to low test sensitivity. The present study aimed to identify the early clinical diagnostic factors for NAIS in neonates with seizures.
The present study included 54 patients born at ≥36 weeks of gestation during the last 15 years who presented to the neonatal intensive care unit with neonatal seizures and underwent brain magnetic resonance imaging (MRI), 6 of whom were diagnosed with NAIS. Maternal background, clinical characteristics, and transcranial pulsed Doppler sonography results were retrospectively reviewed.
Of the 24 patients who presented with convulsions or subtle seizures, 3 (13%) were diagnosed with NAIS and 3 of 30 patients (10%) presented with apnea. Maternal premature ventricular contraction complications were higher in the NAIS group than in the non-NAIS group (p = 0.01). NAIS group showed lower mean middle cerebral artery (MCA) resistance index (RI) was lower the non-NAIS group (p = 0.009), while the left-right RI difference (p = 0.019), mean MCA blood velocity (MnV; p = 0.04), and left-right MnV difference (p < 0.001) in cerebral blood flow velocities (CBFVs) were higher in the NAIS group.
Our results revealed that maternal arrhythmia may be a diagnostic factor for NAIS in neonates with seizures. Early brain MRI is essential in neonates with seizures and findings of low MCA-RI, high MCA-MnV, or high left-right difference in CBFVs to distinguish between NAIS and non-NAIS.
新生儿动脉缺血性脑卒中（NAIS）可表现为癫痫发作，包括惊厥、轻微癫痫发作和呼吸暂停，大多数患者存在神经后遗症。由于检测敏感性低，诊断往往被延误。本研究旨在确定伴有癫痫发作的新生儿 NAIS 的早期临床诊断因素。
本研究纳入了过去 15 年在我院新生儿重症监护病房就诊的 54 例胎龄≥36 周的新生儿，这些新生儿均因新生儿癫痫发作而接受了脑部磁共振成像（MRI）检查，其中 6 例被诊断为 NAIS。回顾性分析了这些患儿的母体背景、临床特征和经颅脉冲多普勒超声检查结果。
在表现为惊厥或轻微癫痫发作的 24 例患儿中，有 3 例（13%）被诊断为 NAIS，而在 30 例表现为呼吸暂停的患儿中，有 3 例（10%）被诊断为 NAIS。NAIS 组的母体室性早搏并发症发生率高于非 NAIS 组（p=0.01）。NAIS 组的大脑中动脉（MCA）阻力指数（RI）均值较低（p=0.009），而左右 RI 差值（p=0.019）、MCA 平均血流速度（MnV；p=0.04）和左右 MnV 差值（p<0.001）在脑血流速度（CBFV）中较高。
我们的结果表明，母体心律失常可能是新生儿伴发癫痫的诊断因素。对于伴有癫痫发作的新生儿，早期脑 MRI 是必要的，如果发现 MCA-RI 降低、MCA-MnV 升高或 CBFV 的左右差异升高，则有助于鉴别 NAIS 和非 NAIS。
