Vastsündinu insult – haigestumus Eestis

Insult vastsündinueas on raske tüsistus, mis on senini olnud aladiagnoositud, kuid tänu radioloogiliste uurimismeetodite täiustumisele on selle diagnoosimine kõikjal sagenenud. Neonataalse insuldi kliinilisele pildile on iseloomulik fokaalsete krampide, apnoehoogude ja teadvushäirete esinemine, hiljem avalduvad lastel hemiparees, epilepsia ning kognitiivsete funktsioonide häired. Eestis tehtud epidemioloogilise uuringu senised tulemused näitavad, et vastsündinuea isheemilise insuldi esmashaigestumus oli aastatel 1998–2002 üks juht 2000 ja 2003. aastal 1 juht 1200 elussünni kohta. Artiklis on käsitletud neonataalse insuldi epidemioloogiat, tekkepõhjusi, riskitegureid ja diagnoosimist. Eesti Arst 2004; 83 (5): 296–30

Antenataalne periventrikulaarne venoosne insult ema rasedusaegse uroinfektsiooni järel

Eesti Arst 2021; 100(9):506–50

Kõnekeskuse lateralisatsioon ja kaugtulemused erineva vaskulaarse alatüübiga perinataalse insuldiga lastel

Eesti Arst 2022; 101(12):71

Ipsilesional volume loss of basal ganglia and thalamus is associated with poor hand function after ischemic perinatal stroke

Background Perinatal stroke (PS) is the leading cause of hemiparetic cerebral palsy (CP). Involvement of the corticospinal tract on neonatal magnetic resonance imaging (MRI) is predictive of motor outcome in patients with hemiparetic CP. However, early MRI is not available in patients with delayed presentation of PS and prediction of hemiparesis severity remains a challenge. Aims To evaluate the volumes of the basal ganglia, amygdala, thalamus, and hippocampus following perinatal ischemic stroke in relation to hand motor function in children with a history of PS and to compare the volumes of subcortical structures in children with PS and in healthy controls. Methods Term born PS children with arterial ischemic stroke (AIS) (n = 16) and with periventricular venous infarction (PVI) (n = 18) were recruited from the Estonian Pediatric Stroke Database. MRI was accuired during childhood (4-18 years) and the volumes of the basal ganglia, thalamus, amygdala and hippocampus were calculated. The results of stroke patients were compared to the results of 42 age- and sex-matched healthy controls. Affected hand function was evaluated by Assisting Hand Assessment (AHA) and classified by the Manual Ability Classification System (MACS). Results Compared to the control group, children with AIS had smaller volumes of the ipsi- and contralesional thalami, ipsilesional globus pallidus, nucleus accumbens and hippocampus (p 0.5; p < 0.05) and larger volume of the contralesional putamen and hippocampus (r < - 0.5; p < 0.05). In children with PVI, size of the ipsilesional caudate nucleus, globus pallidus, thalamus (p 0.55; p < 0.05) in children with PVI. Conclusions Smaller volume of ipsilesional thalamus was associated with poor affected hand function regardless of the perinatal stroke subtype. The pattern of correlation between hand function and volume differences in the other subcortical structures varied between children with PVI and AIS. Evaluation of subcortical structures is important in predicting motor outcome following perinatal stroke.Peer reviewe

Long-term neurodevelopmental outcome after perinatal arterial ischemic stroke and periventricular venous infarction

Background: Long-term follow-up data after different vascular types of ischemic perinatal stroke is sparse. Our aim was to study neurodevelopmental outcomes following neonatal and presumed perinatal ischemic middle cerebral artery territory stroke (arterial ischemic stroke, AIS) and periventricular venous infarction (PVI). Methods: A prospective consecutive cohort of 40 term-born children with perinatal stroke (21 AIS, 19 PVI) was identified through the Estonian Paediatric Stroke Database. While 48% of the children with AIS were diagnosed during the neonatal period, all the children with PVI had presumed perinatal stroke. Outcomes based on the Paediatric Stroke Outcome Measure (PSOM) and Kaufman Assessment Battery for Children Second Edition (K-ABC-II), in relation to extent and laterality of stroke, were defined. Results: At a median age of 7 years 6 months (range 3.6-13y), there was a trend towards worse neurodevelopmental outcome in participants with AIS when compared to PVI (mean total PSOM scores 3.1 and 2.2, respectively; p = 0.06). Combined deficits of motor, language and cognitive/behavioural functions were significantly more common among children with AIS (90%) when compared to children with PVI (53%, p = 0.007). General cognitive ability (by K-ABC-II) was significantly lower in the AIS subgroup (mean 79.6; 95% CI 72.3-87.0), but children with PVI (91.6; 95% CI 85.5-97.8) also had poorer performance than the age-equivalent normative mean. Large extent of stroke was associated with poorer neurodevelopmental outcome and lower cognitive performance in children following AIS but not in PVI. Conclusion: In this national cohort, poor long-term neurodevelopmental outcome after perinatal ischemic stroke was seen irrespective of the vascular type or time of diagnosis of stroke. However, the spectrum of neurological deficits is different after perinatal AIS and PVI, with combined deficits more common among children following AIS. (C) 2018 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Kõnekeskuse reorganisatsioon perinataalse insuldi korral: haigusjuhu kirjeldus

Artiklis on käsitletud 9aastase lapse haigusjuhtu eesmärgiga tutvustada vasema hemisfääri perinataalse insuldi korral kujunevat ajufunktsioonide reorganisatsiooni. Patsiendil teostati funktsionaalne magnetresonantstomograafia (fMRT) motoorse ja sensoorse kõnekeskuse aktivatsioonitestidega. Mõlemad kõnekeskused lokaliseerusid paremas hemisfääris, kusjuures kliiniliselt lapsel kõnehäiret ei esinenud. Eesti Arst 2009; 88(1):52−5

General ability and specific cognitive functions are lower in children with epilepsy after perinatal ischemic stroke

IntroductionEpilepsy develops in one third of children after perinatal stroke. Both epilepsy and stroke may be risk factors for impaired cognitive abilities. How the development of epilepsy is related to the cognitive profile of children with perinatal stroke is still unclear. The aim of the study was to evaluate general and specific cognitive functions in children with epilepsy and children without epilepsy after perinatal ischemic stroke.MethodsThe study group consisted of 51 children with perinatal ischemic stroke confirmed by magnetic resonance imaging: 27 (53%) children with arterial ischemic stroke and 24 (47%) with periventricular venous infarction. Magnetic resonance imaging and electroencephalography were performed in all patients after the neonatal period. Epilepsy was diagnosed if the child had at least two unprovoked seizures occurring &gt;24 h apart or one unprovoked seizure with a high recurrence risk. Cognitive assessments were performed using the Kaufman Assessment Battery for Children, Second Edition, at the age of ≥7 years. General ability (Fluid Crystallized Index, Mental Processing Index, Non-verbal Index) and specific cognitive functions (sequential processing, simultaneous processing, learning, planning, knowledge) were evaluated.ResultsAt the median age of 19.3 years (interquartile range 14.0–22) at the time of follow-up for epilepsy, 14 (27.5%) patients had developed epilepsy, and 37 (72.5%) patients were without epilepsy. All general cognitive ability scores were lower in children with epilepsy compared to children without epilepsy. Among specific cognitive functions, simultaneous processing, planning, and knowledge were lower in children with epilepsy compared to children without epilepsy: simultaneous processing mean [78.5, 95% CI: [69.8, 87.2], vs. 96.9, 95% CI [90, 103.9], p = 0.0018]; planning mean [82.5, 95% CI: [73, 92], vs. 96.2, 95% CI: [88.7, 103.6], p = 0.026]; knowledge median (25th, 75th percentile): 80.5 (75, 87) vs. 92 (84, 108), p = 0.023.ConclusionChildren with epilepsy after perinatal ischemic stroke have lower general cognitive abilities compared to children without epilepsy. The profile of the subscales indicates lower verbal abilities and executive functions in children with epilepsy. Children with post-stroke epilepsy need targeted cognitive monitoring for early aimed rehabilitation and for establishing an adapted learning environment

Epilepsy after perinatal stroke with different vascular subtypes

Objective: With an incidence up to 63/100,000 live births, perinatal stroke is an important cause of childhood epilepsy. The aim of the study was to find the prevalence and predictive factors of epilepsy, and to describe the course of epilepsy of children with perinatal stroke with different vascular subtypes. Methods: Patients were retrieved from Estonian Paediatric Stroke Database with follow-up time at least 24 months. Patients were divided into five perinatal stroke syndromes: neonatal arterial ischemic stroke (AIS), neonatal hemorrhagic stroke, neonatal cerebral sinovenous thrombosis, presumed AIS, and presumed periventricular venous infarction. Results: Final study group included 73 children with perinatal stroke (39 boys). With median follow-up time 8.6 years, epilepsy was diagnosed in 21/73 (29%) children, most of whom had AIS (17/21, 81%). The 18-year cumulative post-stroke epilepsy risk according to Kaplan-Meier estimator was 40.8% (95%CI: 20.7–55.9%). The median age at epilepsy diagnosis was 50 months (range 1 month to 18.4 years). Children with neonatal AIS had the highest risk of epilepsy, but children with presumed AIS had more often severe epilepsy syndromes. Cortical lesions (OR 19.7; 95%CI 2.9–133), involvement of thalamus (OR 9.8; 95%CI: 1.8–53.5) and temporal lobe (OR 8.3; 95%CI: 1.8–39.6) were independently associated with post-stroke epilepsy. Significance: The risk for poststroke epilepsy after perinatal stroke depends on the vascular subtype. Patients with perinatal AIS need close follow-up to detect epilepsy and start with antiepileptic treatment on time. This article is protected by copyright. All rights reserved.Peer reviewe