TY - JOUR
T1 - Association of Acute Infarct Topography With Development of Cerebral Palsy and Neurologic Impairment in Neonates With Stroke
AU - MacKay, Mark T.
AU - Chen, Jian
AU - Shapiro, Jesse
AU - Pastore-Wapp, Manuela
AU - Slavova, Nedelina
AU - Grunt, Sebastian
AU - Stojanovski, Belinda
AU - Steinlin, Maja
AU - Beare, Richard J.
AU - Yang, Joseph Yuan Mou
N1 - Funding Information:
This research was supported by The Royal Children's Hospital Foundation, Murdoch Children's Research Institute, The University of Melbourne, Department of Paediatrics, and the Victorian Government's Operational Infrastructure Support Program. We would like to thank the staff of the individual centers of the Swiss Neuropediatric Stroke Registry and Dr Maria Regenyi from Bern, who helped with data collection.
Funding Information:
Study funding: M. Mackay received grant funding from the Cerebral Palsy Alliance. Financial disclosures: M. Mackay reports no other financial disclosures relevant to the manuscript. J. Chen reports no financial disclosures relevant to the manuscript. J. Shapiro reports no financial disclosures relevant to the manuscript. N. Slavova reports no financial disclosures relevant to the manuscript. M, Pastore-Wapp reports no financial disclosures relevant to the manuscript. S. Grunt reports no financial disclosures relevant to the manuscript. B. Stojanovski reports no financial disclosures relevant to the manuscript. M. Steinlin reports no financial disclosures relevant to the manuscript. R. Beare reports no financial disclosures relevant to the manuscript. J. Yang reports no financial disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Publisher Copyright:
Copyright © 2023 American Academy of Neurology.
PY - 2023/10/10
Y1 - 2023/10/10
N2 - Background and ObjectivesResearch investigating neonatal arterial ischemic stroke (NAIS) outcomes have shown that combined cortical and basal ganglia infarction or involvement of the corticospinal tract predict cerebral palsy (CP). The research question was whether voxel-based lesion-symptom mapping (VLSM) on acute MRI can identify brain regions associated with CP and neurodevelopmental impairments in NAIS.MethodsNewborns were recruited from prospective Australian and Swiss pediatric stroke registries. CP diagnosis was based on clinical examination. Language and cognitive-behavioral impairments were assessed using the Pediatric Stroke Outcome Measure, dichotomized to good (0-0.5) or poor (≥1), at ≥18 months of age. Infarcts were manually segmented using diffusion-weighted imaging, registered to a neonatal-specific brain template. VLSM was conducted using MATLAB SPM12 toolbox. A general linear model was used to correlate lesion masks with motor, language, and cognitive-behavioral outcomes. Voxel-wise t-statistics were calculated, correcting for multiple comparisons using family-wise error (FWE) rate.ResultsEighty-five newborns met the inclusion criteria. Infarct lateralization was left hemisphere (62%), right (8%), and bilateral (30%). At a median age of 2.1 years (interquartile range 1.9-2.6), 33% developed CP and 42% had neurologic impairments. Fifty-four grey and white matter regions correlated with CP (t > 4.33; FWE < 0.05), including primary motor pathway regions, such as the precentral gyrus, and cerebral peduncle, and regions functionally connected to the primary motor pathway, such as the pallidum, and corpus callosum motor segment. No significant correlations were found for language or cognitive-behavioral outcomes.DiscussionCP after NAIS correlates with infarct regions directly involved in motor control and in functionally connected regions. Areas associated with language or cognitive-behavioral impairment are less clear.
AB - Background and ObjectivesResearch investigating neonatal arterial ischemic stroke (NAIS) outcomes have shown that combined cortical and basal ganglia infarction or involvement of the corticospinal tract predict cerebral palsy (CP). The research question was whether voxel-based lesion-symptom mapping (VLSM) on acute MRI can identify brain regions associated with CP and neurodevelopmental impairments in NAIS.MethodsNewborns were recruited from prospective Australian and Swiss pediatric stroke registries. CP diagnosis was based on clinical examination. Language and cognitive-behavioral impairments were assessed using the Pediatric Stroke Outcome Measure, dichotomized to good (0-0.5) or poor (≥1), at ≥18 months of age. Infarcts were manually segmented using diffusion-weighted imaging, registered to a neonatal-specific brain template. VLSM was conducted using MATLAB SPM12 toolbox. A general linear model was used to correlate lesion masks with motor, language, and cognitive-behavioral outcomes. Voxel-wise t-statistics were calculated, correcting for multiple comparisons using family-wise error (FWE) rate.ResultsEighty-five newborns met the inclusion criteria. Infarct lateralization was left hemisphere (62%), right (8%), and bilateral (30%). At a median age of 2.1 years (interquartile range 1.9-2.6), 33% developed CP and 42% had neurologic impairments. Fifty-four grey and white matter regions correlated with CP (t > 4.33; FWE < 0.05), including primary motor pathway regions, such as the precentral gyrus, and cerebral peduncle, and regions functionally connected to the primary motor pathway, such as the pallidum, and corpus callosum motor segment. No significant correlations were found for language or cognitive-behavioral outcomes.DiscussionCP after NAIS correlates with infarct regions directly involved in motor control and in functionally connected regions. Areas associated with language or cognitive-behavioral impairment are less clear.
UR - http://www.scopus.com/inward/record.url?scp=85174641386&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000207705
DO - 10.1212/WNL.0000000000207705
M3 - Article
C2 - 37591776
AN - SCOPUS:85174641386
SN - 0028-3878
VL - 101
SP - e1509-e1520
JO - Neurology
JF - Neurology
IS - 15
ER -