Pediatric ischemic stroke – an unlikely diagnosis: a report of three cases

Pediatric ischemic stroke is a rare and devastating disease. A patient presenting with acute neurological deficit should raise suspicion of a possible stroke. However, stroke “mimics” account for a majority of suspected stroke cases in childhood. We present three cases of pediatric acute ischemic stroke, two of which are arterial, and one caused by thrombosis of venous sinuses. In the first case, we present a 16-year old male patient was admitted to our hospital due to a rare Artery of Percheron occlusion. The second case represents a 17-year old female patient with thrombosis of multiple cerebral venous sinuses, venous infarctions and secondary hemorrhages. As the third case, we present 6-year old male patient with a herpes simplex infection and a vertebrobasilar stroke. All three patients had experienced an altered mental status and other nonspecific symptoms. Due to its rarity, diverse clinical presentation, and lack of randomized control trials regarding treatment, ischemic stroke poses a great challenge to pediatricians

Ultrasonography and Magnetic Resonance Imaging of the Brain in Hypoxic Full-Term Newborns

The aim of this article was to review the studies on diagnostic and prognostic value of radiological investigations (cranial sonography, Doppler ultrasonography, and magnetic resonance imaging) in the detection of hypoxic-ischemic brain injuries in full-term newborns. Materials and Methods. A systematic search of studies on the diagnostic and prognostic possibilities of radiological investigations for the detection of hypoxic-ischemic injuries in full-term newborns was performed. Results. A total of 13 prospective and 4 retrospective studies that analyzed the incidence of hypoxic-ischemic cerebral injuries, determined by means of cranial sonography, Doppler sonography, and magnetic resonance imaging, and associations with the stages of hypoxic-ischemic encephalopathy and long-term neurodevelopmental outcomes were included in this systematic review. Conclusions. Magnetic resonance imaging detects lesions in 75%–100% of cases. Magnetic resonance imaging performed at the age of 7–11 days demonstrated a high sensitivity (100%) and negative predictive value (100%) to predict unfavorable outcomes at 4 years of age. In newborns with hypoxic-ischemic encephalopathy, substantial cerebral hemodynamic alterations are detected after birth. The sensitivity and negative predictive value of cerebral blood flow velocities (peak systolic flow velocity, end-diastolic flow velocity) changes at 12±2 hours of age to predict the severity of hypoxic-ischemic encephalopathy and unfavorable outcomes at 18 months of age were found to be high (90% and 94%, respectively). A low resistive index (<0.56) at the age of 1–3 days had a specificity of 95% to predict unfavorable outcomes at 3 years of age. The data on the diagnostic and prognostic potential of cranial sonography are limited scarce and contrary

The value of ultrasonography and Doppler sonography in prognosticating long-term outcomes among full-term newborns with perinatal asphyxia

Background and objective: The aim of the study was to determine the correlation of hypoxic-ischemic (HI) brain injury in full-term neonates detected via ultrasonography (USG) and blood flow parameters evaluated via Doppler sonography (DS) with long-term outcomes of mental and neuromotor development at the age of 1-year. Materials and methods: In total, 125 full-term neonates (78 subjects of case group and 47 subjects of control group) were studied. During the first five days of life, the subjects daily underwent cerebral USG and DS. At the age of 1-year the neuromotor condition and mental development was evaluated. Results: The HI injury groups detected during USG significantly correlated with the mental development groups (r = 0.3; P = 0.01) and the neurological evaluation groups (r = 0.3; P < 0.001). In the presence of brain swelling (edema) and thalamus and/or basal ganglia (E/T/BG) injury, USG demonstrated high accuracy values when prognosticating spastic quadriparesis and severe mental development impairment in 1-year-old subjects: sensitivity – 100%, specificity – 93–100%, positive predictive value (PPV) – 60–100%, and NPV – 100%. In subjects with spastic quadriparesis, mean end-diastolic velocity (Vd) values were significantly higher (P ≤ 0.05), and mean resistive index (RI) values were significantly lower (P < 0.05) than those in subjects with normal neuromotor development. In subjects with severe mental retardation, mean Vd values in ACA were statistically significantly higher, and mean RI values in ACA and ACM were statistically significantly lower than those in subjects with normal mental development. Conclusions: Hypoxic-ischemic brain changes detected during ultrasonography and cerebral blood flow parameters associated with long-term outcomes of mental and neuromotor development at the age of 1-year

Long-Term Outcomes of Perinatal Hypoxia and Asphyxia at an Early School Age

Background and Objectives: Late long-term outcomes of perinatal asphyxia (PA) in school-age are often unclear. To assess long-term outcomes at an early school age in children who had experienced perinatal hypoxia or asphyxia, where therapeutic hypothermia was not applied. Materials and Methods: The case group children were 8–9-year-old children (n = 32) who were born at full term and experienced hypoxia or asphyxia at birth, where therapeutic hypothermia (TH) was not applied. The control group consisted of 8–9-year-old children (n = 16) born without hypoxia. A structured neurological examination was performed at an early school age. The neuromotor function was assessed using the Gross Motor Function Classification System (GMFCS). Health-related quality-of-life was assessed using the Health Utilities Index (HUI) questionnaire. Intellectual abilities were assessed using the Wechsler Intelligence Scale for Children (WISC). Results: The case group, compared with controls, had significantly (p = 0.002) lower mean [SD] full-scale IQ (87(16.86) vs. 107(12.15)), verbal-scale IQ (89(17.45) vs. 105(11.55)), verbal comprehension index (89(17.36) vs. 105(10.74)), working memory index (89(15.68) vs. 104(11.84)), performance IQ (87(16.51) vs. 108(15.48)) and perceptual organization index (85(15.71) vs. 105(15.93)). We did not find any significant differences in the incidence of disorders of neurological examination, movement abilities and health-related quality of life at an early school age between the case and the control group children. Conclusion: In children who experienced perinatal asphyxia but did not have cerebral paralysis (CP), where therapeutic hypothermia was not applied, cognitive assessment scores at an early school age were significantly lower compared to those in the group of healthy children, and were at a low average level