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New Insights in Perinatal Arterial Ischemic Stroke by Assessing Brain Perfusion

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Abstract

Perinatal arterial ischemic stroke (AIS) is an important cause of long-term morbidity in children. Thus, there is an urgent need to better understand the mechanisms of stroke in newborns in order to develop effective treatment and prevention strategies. The purpose of this study was to assess brain perfusion within the first month of life in newborns with AIS. In this study, magnetic resonance imaging (MRI) and perfusion imaging by arterial spin labeling (ASL) were used to assess brain perfusion in four term newborns with AIS. One patient had a stroke within the territory of the right middle cerebral artery (MCA); the other three patients had a stroke within the territory of the left MCA. None of them displayed any hemorrhagic component. All four patients demonstrated abnormal brain perfusion in the stroke area. Cerebral blood flow (CBF) within the stroke area was increased in patient # 1. In all other three patients, CBF was decreased within the stroke center and increased in the periphery of the stroke area. These results show the feasibility of the ASL sequence in newborns with AIS and support its addition to the current MRI protocol used in these newborns as it provides useful information on brain hemodynamics. Its value for identifying salvageable tissue in newborns needs to be further assessed, as well as its potential role in stroke follow-up and for tissue-specific treatment screening.

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Abbreviations

AIS:

Arterial ischemic stroke

ASL-PI:

Perfusion imaging by arterial spin labeling

BG:

Basal ganglia

CBF:

Cerebral blood flow

CGM:

Cortical gray matter

DWI:

Diffusion-weighted imaging

MCA:

Middle cerebral artery

MRI:

Magnetic resonance imaging

ROIs:

Regions of interest

WM:

White matter

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Acknowledgments

Pia Wintermark receives research grant funding from the William Randolph Hearst Fund Award and the Thrasher Research Fund Early Career Award Program. The work of Simon K. Warfield is supported by NIH grants R01 RR021885, R01 GM074068, R03 EB008680, and P30 HD018655. The authors thank Aaron Johnstone for his thorough review of the manuscript.

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Authors and Affiliations

  1. Division of Newborn Medicine, Montreal Children’s Hospital, McGill University, 2300 rue Tupper, C-920, Montreal, QC, H3H 1P3, Canada

    Pia Wintermark

  2. Division of Newborn Medicine, Children’s Hospital Boston, Boston, MA, USA

    Pia Wintermark

  3. Department of Radiology, Children’s Hospital Boston, Boston, MA, USA

    Pia Wintermark & Simon K. Warfield

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  1. Pia Wintermark
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  2. Simon K. Warfield
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Correspondence to Pia Wintermark.

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Wintermark, P., Warfield, S.K. New Insights in Perinatal Arterial Ischemic Stroke by Assessing Brain Perfusion. Transl. Stroke Res. 3, 255–262 (2012). https://doi.org/10.1007/s12975-011-0122-0

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  • DOI: https://doi.org/10.1007/s12975-011-0122-0

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