急性梗死部位与卒中新生儿脑瘫和神经功能障碍的相关性。
Association of Acute Infarct Topography With Development of Cerebral Palsy and Neurologic Impairment in Neonates With Stroke.
机构信息
From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland.
出版信息
Neurology. 2023 Oct 10;101(15):e1509-e1520. doi: 10.1212/WNL.0000000000207705. Epub 2023 Aug 17.
BACKGROUND AND OBJECTIVES
Research investigating neonatal arterial ischemic stroke (NAIS) outcomes have shown that combined cortical and basal ganglia infarction or involvement of the corticospinal tract predict cerebral palsy (CP). The research question was whether voxel-based lesion-symptom mapping (VLSM) on acute MRI can identify brain regions associated with CP and neurodevelopmental impairments in NAIS.
METHODS
Newborns were recruited from prospective Australian and Swiss pediatric stroke registries. CP diagnosis was based on clinical examination. Language and cognitive-behavioral impairments were assessed using the Pediatric Stroke Outcome Measure, dichotomized to good (0-0.5) or poor (≥1), at ≥18 months of age. Infarcts were manually segmented using diffusion-weighted imaging, registered to a neonatal-specific brain template. VLSM was conducted using MATLAB SPM12 toolbox. A general linear model was used to correlate lesion masks with motor, language, and cognitive-behavioral outcomes. Voxel-wise -statistics were calculated, correcting for multiple comparisons using family-wise error (FWE) rate.
RESULTS
Eighty-five newborns met the inclusion criteria. Infarct lateralization was left hemisphere (62%), right (8%), and bilateral (30%). At a median age of 2.1 years (interquartile range 1.9-2.6), 33% developed CP and 42% had neurologic impairments. Fifty-four grey and white matter regions correlated with CP ( > 4.33; FWE < 0.05), including primary motor pathway regions, such as the precentral gyrus, and cerebral peduncle, and regions functionally connected to the primary motor pathway, such as the pallidum, and corpus callosum motor segment. No significant correlations were found for language or cognitive-behavioral outcomes.
DISCUSSION
CP after NAIS correlates with infarct regions directly involved in motor control and in functionally connected regions. Areas associated with language or cognitive-behavioral impairment are less clear.
背景与目的
研究新生儿动脉缺血性脑卒中（NAIS）的结果表明，皮质和基底节梗死的联合或皮质脊髓束的受累可预测脑瘫（CP）。研究问题是，急性 MRI 的基于体素的病变-症状映射（VLSM）是否可以识别与 CP 和 NAIS 神经发育障碍相关的脑区。
方法
从前瞻性澳大利亚和瑞士儿科卒中登记处招募新生儿。CP 的诊断基于临床检查。语言和认知行为障碍使用儿科卒中结局测量（PSOM）进行评估，在 ≥18 个月时分为良好（0-0.5）或差（≥1）。使用弥散加权成像手动分割梗死，注册到新生儿特定的脑模板。使用 MATLAB SPM12 工具箱进行 VLSM。使用一般线性模型将病变掩模与运动、语言和认知行为结果相关联。使用体素 - 统计进行计算，使用全方差错误（FWE）率校正多重比较。
结果
85 名新生儿符合纳入标准。梗死偏侧性为左侧（62%）、右侧（8%）和双侧（30%）。在中位数年龄为 2.1 岁（四分位间距 1.9-2.6）时，33%的新生儿发展为 CP，42%的新生儿有神经发育障碍。54 个灰质和白质区域与 CP 相关（ > 4.33；FWE < 0.05），包括初级运动通路区域，如中央前回和大脑脚，以及与初级运动通路功能连接的区域，如苍白球和胼胝体运动段。未发现语言或认知行为结果的显著相关性。
讨论
NAIS 后 CP 与直接参与运动控制的梗死区域以及功能连接区域相关。与语言或认知行为障碍相关的区域不太清楚。
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