Arias-Llorente R P, Lareu-Vidal S, González-Sánchez S, Blanco-Lago R
Hospital Universitario Central de Asturias, Oviedo, España.
Hospital Universitario Central de Asturias, 33006 Oviedo, España.
Rev Neurol. 2023 Oct 1;77(7):151-158. doi: 10.33588/rn.7707.2023158.
Perinatal arterial ischaemic stroke (PAIS) is almost as common as in adulthood and causes significant neurological sequelae.
The aim is to describe the risk situations surrounding these neonates, the clinical manifestations, the management, the cost-effectiveness of diagnostic tests and the neurological sequelae.
We conducted an observational study of a cohort of patients consisting of neonates with a gestational age = 35 weeks diagnosed with PAIS in our hospital between 2010 and 2021.
Twenty-two cases of PAIS were included, and the incidence in our centre was 1/1,869 live newborns. The data showed that 81.8% had some intrapartum risk factor and 40.9% had a combination of several risk factors. It started with seizures (mean age 27.3 hours) in 77.3% of cases. Patients with a stroke in the left hemisphere had more sequelae (77.8%) than those with a stroke on the right-hand side (16.6%) (p = 0.041), with the exception of infantile cerebral palsy (p = 0.04), while we found no difference between hemispheres in the frequency of language impairment (p = 0.06). The mean follow-up time was 6.13 ± 3.06 years. A total of 63.6% of infants had neurological sequelae: infantile cerebral palsy (40.9%), language disorders (22.7%) and intellectual disability (9%). Moreover, 18.2% developed epilepsy (between 0.25 and 1.8 years) and antiseizure treatment was maintained after discharge in 37.5% of cases in the last years of the study.
If a newborn infant presents seizures, it is necessary to rule out the possibility of a stroke. PAIS causes neurological sequelae in over 60% of cases. Early identification is essential to improve the neurological prognosis and avoid the prolonged use of antiseizure drugs where possible.
围产期动脉缺血性卒中（PAIS）在新生儿期的发病率几乎与成人期相当，并会导致严重的神经后遗症。
旨在描述这些新生儿周围的风险情况、临床表现、治疗方法、诊断检查的成本效益以及神经后遗症。
我们对一组患者进行了观察性研究，这些患者为2010年至2021年间在我院确诊为PAIS且胎龄≥35周的新生儿。
共纳入22例PAIS病例，我院的发病率为1/1869活产新生儿。数据显示，81.8%的病例存在一些产时危险因素，40.9%的病例存在多种危险因素组合。77.3%的病例以癫痫发作起病（平均年龄27.3小时）。左半球卒中的患者比右半球卒中的患者有更多的后遗症（77.8%对16.6%）（p = 0.041），婴儿脑瘫除外（p = 0.04），而我们发现半球之间语言障碍的频率没有差异（p = 0.06）。平均随访时间为6.13±3.06年。共有63.6%的婴儿有神经后遗症：婴儿脑瘫（40.9%）、语言障碍（22.7%）和智力残疾（9%）。此外，18.2%的患儿发生癫痫（0.25至1.8岁之间），在研究的最后几年，37.5%的病例出院后仍维持抗癫痫治疗。
如果新生儿出现癫痫发作，有必要排除卒中的可能性。PAIS在超过60%的病例中会导致神经后遗症。早期识别对于改善神经预后和尽可能避免长期使用抗癫痫药物至关重要。
