Document Detail

Diagnosis of perinatal stroke II: mechanisms and clinical phenotypes.
MedLine Citation:
PMID:  19673723     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Here (and in an accompanying article dealing with definitions, differential diagnosis and registration), a structured sequential diagnostic flow is proposed to discern clinical phenotypes for perinatal stroke, including arterial ischaemic stroke (AIS), cerebral sinovenous thrombosis (CSVT) and haemorrhagic stroke. MATERIAL AND RESULTS: For neonatal AIS, the diagnostic sequence is infection, trauma, embolism, arteriopathy, other, primary thrombosis and unclassifiable; for neonatal CSVT, the sequence is infection, trauma, venopathy, other, primary thrombosis and unclassifiable. The proposed hierarchical diagnostic flows are an initial step towards a standard for registration of the causes of neonatal stroke. Such standardization should guide attempts at prevention and intervention. An extensive literature search and study of a retrospective cohort of 134 newborn infants with stroke suggest that embolism is the most common identifiable cause for stroke in general (25%), preceding trauma (10%) and infection (8%). Other causes, such as asphyxia, acute blood loss, extracorporeal membrane oxygenation, genetic disorders or prothrombotic conditions, are seen in <5% of cases. For neonatal AIS, the presence of an embolic phenotype is 33% in this cohort. The designation unclassifiable scored 34% for the entire stroke group and 25% for neonatal AIS. Complex arterial stroke with multiple arteries involved is often seen when the underlying cause is infection, cranial trauma or embolism. One important conclusion is that a means of prevention is avoidance of embolism from thrombosis outside the brain. CONCLUSION: To prevent the occurrence and recurrence of neonatal ischaemic stroke, clinicians must develop a standardized diagnostic approach that results in characterization of the clinical phenotype.
P Govaert; L Ramenghi; R Taal; J Dudink; M Lequin
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-08-10
Journal Detail:
Title:  Acta paediatrica (Oslo, Norway : 1992)     Volume:  98     ISSN:  1651-2227     ISO Abbreviation:  Acta Paediatr.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-07     Completed Date:  2009-12-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9205968     Medline TA:  Acta Paediatr     Country:  Norway    
Other Details:
Languages:  eng     Pagination:  1720-6     Citation Subset:  IM    
Department of Neonatology, Sophia Children's Hospital Erasmus MC, Rotterdam, the Netherlands.
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MeSH Terms
Brain Ischemia / etiology
Cerebral Arterial Diseases / etiology
Infant, Newborn
Infant, Newborn, Diseases / classification,  diagnosis*,  etiology
Intracranial Hemorrhages / etiology
Risk Factors
Sinus Thrombosis, Intracranial / etiology
Stroke / classification,  diagnosis*,  etiology

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