Cranial Ultrasonography Has a Low Sensitivity for Detecting Arterial Ischemic Stroke in Term Neonates

Abstract

The aim of this study was to investigate the sensitivity of cranial ultrasonography for detecting acute arterial ischemic stroke in term neonates. Thirty-six neonates with gestational age 36 weeks who had cranial ultrasonography followed by computed tomography (CT) or magnetic resonance imaging (MRI) confirming arterial ischemic stroke were identified from a consecutive cohort study of all children diagnosed with arterial ischemic stroke by CT or MRI and seen at Chedoke McMaster Hospital between January 1992 and December 1998 or at The Hospital for Sick Children between January 1992 and December 2000. Cranial ultrasonography demonstrated focal abnormalities in 11 patients, giving the initial cranial ultrasonography a sensitivity of 30.5% for identifying neonates with infarction (95% CI 15.5—45.5%). The sensitivity of cranial ultrasonography performed in the two pediatric referral centers (Chedoke McMaster Hospital and Hospital for Sick Children; n = 19) was higher than that in community hospitals (n = 17) (47.3% versus 11.7%; P =.031). Neonates with suspected infarction should be evaluated with CT or MRI. (J Child Neurol 2003; 18: 98—103).

Get full access to this article

View all access options for this article.

References

Volpe JJ : Neurology of the Newborn. Philadelphia, WB Saunders Company, 2001.

SAS System, 8th ed. Cary, NC , SAS, 1999—2001 .

Childs AM , Cornette L. , Ramenghi LA , et al: Magnetic resonance and cranial ultrasound characteristics of periventricular white matter abnormalities in newborn infants. Clin Radiol 2001; 56: 647—655.

Clancy R. , Malin S. , Laraque D. , et al: Focal motor seizures heralding stroke in full-term neonates . Am J Dis Child 1985;139:601—606.

Mercuri E. , Cowan F. , Rutherford M. , et al: Ischaemic and haemorrhagic brain lesions in newborns with seizures and normal Apgar scores. Arch Dis Child 1995 ;73:F67—F74.

Estan J. , Hope P. : Unilateral neonatal infarction in full term neonates. Arch Dis Child 1997;76:F88—F93.

Hill A. , Martin DJ , Daneman A. , Fitz CR : Focal ischemic cerebral injury in the newborn: Diagnosis by ultrasound and correlation with computed tomographic scan. Pediatrics 1983;71:790—793.

Bode H. , Strassburg HM , Pringsheim W. , Kunzer W. : Cerebral infarction in term neonates: Diagnosis by cerebral ultrasound. Childs Nerv Syst 1986;2:195—199.

Fischer AQ , Anderson JC , Shuman RM : The evolution of ischemic cerebral infarction in infancy: A sonographic evaluation . J Child Neurol 1988;3:105—109.

10.

Nanni GS , Kaude JV , Reeder JD : Ischemic brain infarct in a neonate: Ultrasound diagnosis and follow-up. J Clin Ultrasound 1984;12:229—231.

11.

Hernanz-Schulman M. , Cohen W. , Genieser NB : Sonography of c e r e b r a l i n f a r c t i o n i n i n f a n c y. A J R A m J R o e n t g e n o l 1988;150:897—902.

12.

Koelfen W. , Freund M. , Varnholt V. : Neonatal stroke involving the middle cerebral artery in term infants: Clinical presentation, EEG and imaging studies, and outcome. Dev Med Child Neurol 1995;37:204—212.

13.

de Vries LS , Groenendaal F. , Eken P. , et al: Infarcts in the vascular distribution of the middle cerebral artery in preterm and full-term infants. Neuropediatrics 1997;28:88—96.

14.

Govaert P. , Matthys E. , Zecic A. , et al: Perinatal cortical infarction w i t h i n m i d d l e c e r e b r a l a r t e r y t r u n k s . A r c h D i s C h i l d 2000;82:F59—F63.

15.

Wilson-Davis SL , Lo W. , Filly RA : Limitations of ultrasound in detecting cerebral ischemic lesions in the neonate. Ann Neurol 1983;14:249—251.

16.

Hollier LM : Can neurological injury be timed? Semin Perinatol 2000;24:204—214.

17.

Blankenberg FG , Norbash AM , Lane B. , et al: Neonatal intracranial ischemia and hemorrhage: Diagnosis with US, CT, and MR imaging. Radiology 1996;199:253—259.

18.

Adcock LM , Moore PJ , Schlesinger AE , Armstrong DL : Correlation of ultrasound with postmortem neuropathologic studies in neonates . Pediatr Neurol 1998; 19: 263—271.

19.

Lazar EL , Abramson SJ , Weinstein S. , Stolar CJ : Neuroimaging of brain injury in neonates treated with extracorporeal membrane oxygenation: Lessons learned from serial examinations. J Pediatr Surg 1994;29:186—190; discussion 190—191.

20.

Babcock DS , Ball W. Postasphyxial encephalopathy in full-term infants: Ultrasound diagnosis. Radiology 1983;148:417—423.

21.

Lynch J. , Nelson KB : Neonatal stroke in the United States: Results of the national hospital discharge survey, 1980-1998, abstract. Neurology 2001 ;56:A10.

22.

Lynch JK , Hirtz DG , DeVeber G. , Nelson KB : Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke. Pediatrics 2002;109:116—123.

23.

Andrew ME , Monagle P. , deVeber G. , Chan AK : Thromboembolic disease and antithrombotic therapy in newborns. Blood; American Society of Hematology Conference (Syllabus), 2001.

24.

Golomb M. : Walking after neonatal arterial ischemic stroke and sinovenous thrombosis: Predictors of probability of walking over time and parental perception of gait. Master of Science Thesis (Clinical Epidemiology), Graduate Department of (Health Policy, Management, and Evaluation. Toronto, University of Toronto, 2002, 108.

25.

Amato M. , Huppi P. , Herschkowitz N. , Huber P. : Prenatal stroke suggested by intrauterine ultrasound and confirmed by magnetic resonance imaging. Neuropediatrics 1991;22:100—102.

26.

Robertson RL , Ben-Sira L. , Barnes PD , et al: MR line-scan diffusion-weighted imaging of term neonates with perinatal brain ischemia. AJNR Am J Neuroradiol 1999; 20: 1658—1670.