Background: Neonatal arterial ischemic stroke (AIS) is the most common pediatric stroke occurring in more than 1/4000 live births with a risk of recurrence of less than 1%. The presence of an arteriopathy is associated with high risk of recurrence in childhood stroke. However, The prevalence and risk factors of an arteriopathy in neonatal stroke are not known.
Objective: We sought to characterize the subgroup of neonates with AIS who have abnormal vasculature.
Patients and Methods: This is a single center retrospective case-control study of patients with neonatal stroke from 1991-2012. Charts were reviewed for neonates with AIS and neuroimaging that included vascular imaging (MRI/MRA). Clinical data of patients with abnormal MRA was compared to the control group of neonates with AIS but a normal MRA.
Results: A total of 142 cases of neonatal AIS were identified of which 82 patients had MRI/MRA. Among the neonates with vascular neuroimaging, 30 had abnormal vessels (minimum prevalence rate of 36%). The majority of vascular abnormalities were stenotic or hypoplastic branches. Two patients (7%) had dissection. Young maternal age, positive maternal GBS, C-section delivery, low APGAR scores, low Hgb, and cardiac defects were significantly (p < 0.05) more common in neonates with abnormal vessels.
Conclusion: Neurovascular imaging is challenging in neonates so often not performed. However, we recommend that an MRA to be performed in neonates with AIS who have any of the risk factors identified in this study. Early diagnosis of their vasculopathy may change their stroke management and impact outcome.