Background: Perinatal stroke causes cerebral palsy and lifelong disability. Specific diseases are definable but pathophysiological mechanisms are unknown. Arterial tortuosity may reflect inherent vascular biology. We recently demonstrated an association between abnormal tortuosity and specific arteriopathies in childhood stroke.
Hypothesis: As fetal periventricular infarction (PVI) has been associated with genetic connective tissue disease, we hypothesized that tortuosity would be increased in PVI compared to other perinatal stroke diseases and controls.
Methods: Subjects were recruited from the Alberta Perinatal Stroke Project (APSP), a population-based research cohort. Inclusion criteria were MRI-classified perinatal stroke syndrome and 3D time-of-flight MR angiography (MRA). A validated imaging software method calculated cerebral arterial tortuosity using source images. Mean tortuosity scores (ANOVA) and variances (Levene’s test) were compared across arterial ischemic, hemorrhagic, and PVI strokes and controls. Effects of age and gender were examined.
Results: A total of 130 children were studied (61 arterial, 30 PVI, 15 hemorrhagic, 24 controls). Tortuosity scores and variances were consistent with validation studies. Tortuosity was not associated with age at imaging (including infants versus older children) or gender. Variance in tortuosity was much greater in all perinatal stroke groups compared to controls (p<0.0008) with no differences between specific stroke types found. There was no difference in mean tortuosity scores across groups.
Conclusion: Children with perinatal stroke have an abnormally wide range of arterial tortuosity, suggesting inherent differences in vascular biology. This is consistent with genetic connective tissue disorders associated with PVI while suggesting novel mechanisms for other perinatal stroke diseases.