Risk Factors and Presentations of Periventricular Venous Infarction vs Arterial Presumed Perinatal Ischemic Stroke

Abstract

OBJECTIVE: To determine whether clinical presentations and risk factor profiles differ between periventricular venous infarction (PVI) and arterial presumed perinatal ischemic stroke (APPIS). DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 59 children with presumed perinatal ischemic stroke (PPIS) from the SickKids Children's Stroke Program who were carried to term (63% boys). SETTING: Single tertiary care center subspecialty program. INTERVENTIONS: Participants had validated magnetic resonance imaging classification to define PVI and APPIS subgroups. MAIN OUTCOME MEASURES: Clinical presentations, times to parental and physician concern, age at diagnosis, and standardized risk factor evaluations including maternal, fetal, obstetrical, neonatal, and prothrombotic variables. Patients with PVI and APPIS were compared using chi(2) or Fisher exact tests and Wilcoxon rank sum or Mann-Whitney U tests. RESULTS: A total of 12 children (20%) had PVI and 47 (80%) had APPIS. Median parental concern was 5 months, with delays to physician concern (7 months) and diagnosis (12 months). Delays were longer in PVI cases compared with APPIS (P = .002). Most presented with asymmetrical motor development but children with APPIS were more likely to present with seizures or nonmotor delays (P = .01). Children with APPIS were more likely to have acute perinatal risk factors (66% vs 17%; P = .002) including fetal distress, emergency caesarian section, or neonatal resuscitation. Cardiac evaluations were unremarkable. Prothrombotic abnormalities were common (44%) including protein S deficiency, lupus anticoagulant, and elevated factor IX but were comparable between APPIS and PVI subgroups. CONCLUSIONS: Diagnosis of PPIS is often delayed. The association of acute perinatal risk factors with APPIS compared with PVI supports distinct timing of these diseases. Prospective, case-control risk factor studies of PPIS subtypes are required to develop prevention strategies.