A Mineyko potpourri

Aleksandra Mineyko, Adam Kirton, Lori Billinghurst, Nana Nino Tatishvili, Max Wintermark, Gabrielle deVeber, Christine Fox on behalf of the SIPS Investigators.  Seizures and outcome one year after neonatal and childhood cerebral sinovenous thrombosis.  Pediatric Neurology.  In press.  https://doi.org/10.1016/j.pediatrneurol.2019.08.012

Abstract

Background

Pediatric cerebral sinovenous thrombosis (CSVT) is a treatable cause of brain injury, acute symptomatic seizures and remote epilepsy. Our objective was to prospectively study epilepsy and neurologic outcomes in neonates and children one year after CSVT diagnosis.

Methods

Patients with CSVT were enrolled prospectively from 21 international sites through the Seizures in Pediatric Stroke (SIPS) Study. Clinical data including acute symptomatic seizures and CSVT risk factors were collected at diagnosis. A blinded neuroradiologist reviewed acute imaging. At one year, outcomes including seizure recurrence, epilepsy diagnosis, anticonvulsant use, and modified Engel score were collected. Neurological outcomes were assessed using the modified Rankin score (mRS) and the King’s Outcome Scale of Childhood Head Injury (KOSCHI).

Results

Twenty-four participants with CSVT were enrolled (67% male, 21% neonates). Headache was the most common presenting symptom in non-neonates (47%, 9/19). Nine (37.5%) presented with acute symptomatic seizures. Six (25%; 95% CI = 10%- 47%) developed epilepsy by 1-year follow-up. No clinical predictors associated with epilepsy were identified. KOSCHI and mRS scores at 1 year were favorable in 71%. Half of CSVT patients who developed epilepsy (3/6) did not have infarcts, hemorrhage, or seizures identified during the acute hospitalization

Conclusion

Our study provides a prospective estimate that epilepsy occurs in approximately one quarter of patients by one year after diagnosis of CSVT. Later epilepsy can develop in the absence of acute seizures or parenchymal injury associated with the CSVT.

Courtesy of:  https://www.mdlinx.com/journal-summaries/pediatric-stroke-cerebral-sino-venous-thrombosis/2019/10/24/7582775?spec=neurology

Mineyko A, Kirton A. Long-Term Outcome After Bilateral Perinatal Arterial Ischemic Stroke. Pediatr Neurol. 2019 Aug 2. pii: S0887-8994(19)30587-9.  doi:10.1016/j.pediatrneurol.2019.07.013. [Epub ahead of print]

Abstract

AIM:

We aimed to characterize the phenotype and outcomes of children with bilateral, large vessel perinatal arterial ischemic stroke.

METHODS:

Patients with bilateral, large vessel perinatal arterial ischemic stroke were identified from a large, population-based cohort (Alberta Perinatal Stroke Project). Subjects were included if stroke involving a major cerebral artery territory was documented in both cerebral hemispheres on magnetic resonance imaging. Standardized variables were extracted from charts including clinical presentations, associated potential risk factors, and outcomes. Outcome measures included the Pediatric Stroke Outcome Measure, Gross Motor Function Classification System, and epilepsy frequency score. Electroencephalographies were reviewed for sleep, epileptiform activity, and background.

RESULTS:

Of 174 children with perinatal arterial ischemic stroke, eight (5%) had bilateral large artery infarcts. Patients were followed for a mean of 9.7 years (range 1.8 to 14.6 years). One child died. All children had a total Pediatric Stroke Outcome Measure of ≥2 (median 8, range 2 to 10) and Gross Motor Function Classification System ≥ II. Seven of eight (88%) children had a history of epilepsy.

CONCLUSIONS:

Children with bilateral, large vessel perinatal stroke are at high risk of severe cognitive and motor sequelae. Epilepsy may also be more common than unilateral strokes. Cautious discussions with families regarding prognosis are recommended.