| Diagnosis of perinatal stroke II: mechanisms and clinical phenotypes. | |
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MedLine Citation:
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PMID: 19673723 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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P Govaert; L Ramenghi; R Taal; J Dudink; M Lequin |
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Publication Detail:
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Type: Journal Article; Review Date: 2009-08-10 |
Journal Detail:
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Title: Acta paediatrica (Oslo, Norway : 1992) Volume: 98 ISSN: 1651-2227 ISO Abbreviation: Acta Paediatr. Publication Date: 2009 Nov |
Date Detail:
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Created Date: 2009-10-07 Completed Date: 2009-12-11 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9205968 Medline TA: Acta Paediatr Country: Norway |
Other Details:
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Languages: eng Pagination: 1720-6 Citation Subset: IM |
Affiliation:
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Department of Neonatology, Sophia Children's Hospital Erasmus MC, Rotterdam, the Netherlands. paul.govaert3@pandora.be |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Brain Ischemia
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etiology Cerebral Arterial Diseases / etiology Humans Infant, Newborn Infant, Newborn, Diseases / classification, diagnosis*, etiology Intracranial Hemorrhages / etiology Phenotype Risk Factors Sinus Thrombosis, Intracranial / etiology Stroke / classification, diagnosis*, etiology |
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