Prediction of Outcome in New-Born Infants with Arterial Ischaemic Stroke Using Diffusion-Weighted Magnetic Resonance Imaging

 

 Buy Article Permissions and Reprints

Abstract

Objective: The aim of this study was to assess the additional value of diffusion-weighted magnetic resonance imaging (DW-MRI) compared to conventional magnetic resonance imaging (MRI) in new-born infants with arterial ischaemic stroke, with regard to the prediction of neurodevelopmental outcome.

Methods: Neonatal DW-MRI data were available in 15 infants with a gestational age of ≥ 35 weeks and repeat MRI data were obtained in 12 of the 14 survivors. T₁- and T₂-weighted transverse images were obtained as well as 4-mm DWI slices. ADC maps were calculated in manually selected regions on the basis of the DWI scans. All 14 survivors were seen in the follow-up clinic and 12 were > 18 months when last seen.

Results: T₂ hyperintensity was detected in the descending white matter tracts at the level of the internal capsule in 7 infants and in only one of these also at the level of the cerebral peduncles. Increased signal intensity (SI) was seen on DW-MRI in 8 infants in the descending white matter tract ipsilateral to the territorial infarct at the level of the internal capsule and in 5 of these also at the level of the cerebral peduncles. ADC maps were available in 12 infants. ADC values were calculated at the level of the cerebral peduncles, using the contralateral side as a reference value. A significantly reduced value was found in 3 of the 5 infants who showed an increased SI on DW-MRI. ADC maps were not available in the other two. Five of the seven infants with abnormalities on DW-MRI/ADC of the corticospinal tracts developed a mild to moderate hemiplegia, one showed an asymmetry of tone and one with only involvement of the anterior part of the internal capsule was normal at follow-up. Wallerian degeneration, seen at the level of the cerebral peduncles and/or the PLIC on the repeat MRI, was seen in the 5 infants who had shown acute changes of the corticospinal tracts in the neonatal period and who went on to develop motor sequelae.

Conclusions: Compared to MRI, DW-MRI and ADC maps provided additional, quantitative data of acute corticospinal tract injury at an early time point after the insult, especially at the level of the cerebral peduncles. The presence of increased SI on DW-MRI at the level of the PLIC and the cerebral peduncles in new-born infants with arterial ischaemic stroke is followed by Wallerian degeneration and subsequent development of hemiplegia.

References

• 1 Abdullah N D, Phillips M D, Matthews V P, Lowe M J. Findings of descending motor fiber injury by diffusion weighted imaging in patients with middle cerebral artery infarction.  AJR Am J Roentgenol. 1999;  172 66
  PubMedGoogle Scholar
• 2 Amiel-Tison C, Grenier A. Evaluation Neurologique du Nouveau-Né et du Nourisson. Paris; Masson 1980
  Google Scholar
• 3 Battin M R, Dezoete A, Gunn T R, Gluckman P D, Gunn A J. Neurodevelopmental outcome of infants treated with head cooling and mild hypothermia after perinatal asphyxia.  Pediatrics. 2001;  107 480-484
  CrossrefPubMedGoogle Scholar
• 4 Bouza H, Dubowitz L M, Rutherford M, Pennock J M. Prediction of outcome in children with congenital hemiplegia: a magnetic resonance study.  Neuropediatrics. 1994;  25 60-66
  PubMedGoogle Scholar
• 5 Castillo M, Mukherji S K. Early abnormalities related to postinfarction Wallerian degeneration: evaluation with MR diffusion-weighted imaging.  J Comput Assist Tomogr. 1999;  23 1004-1007
  CrossrefPubMedGoogle Scholar
• 6 Claeys V, Deonna T, Chrzanowski R. Congenital hemiparesis: the spectrum of lesions, a clinical and computerized tomographic study.  Helv Paediatr Acta. 1983;  38 439-455
  PubMedGoogle Scholar
• 7 Cowan F M, Pennock J M, Hanrahan K P, Manji K P, Edwards D. Early detection of cerebral infarction and hypoxic ischaemic encephalopathy in neonates using diffusion weighted magnetic imaging.  Neuropediatrics. 1994;  25 172-175
  Article in Thieme ConnectPubMedGoogle Scholar
• 8 De Vries L S, Groenendaal F, Eken P, van Haastert I C, Rademaker K J, Meiners L C. Infarcts in the distribution of the middle cerebral artery in preterm and full-term infants.  Neuropediatrics. 1997;  28 88-96
  PubMedGoogle Scholar
• 9 De Vries L S, Groenendaal F, Eken P, Rademaker K J, Meiners L C. Asymmetrical myelination of the posterior limb of the internal capsule: an early predictor of hemiplegia.  Neuropediatrics. 1999;  30 314-319
  PubMedGoogle Scholar
• 10 Dubowitz L MS, Dubowitz V. The Neurological Assessment of the Preterm and Full-Term Infant. Clin Dev Med. No 79. London: SIMP/Heinemann, Philadelphia; Lippincott 1981
  Google Scholar
• 11 Estan J, Hope P. Unilateral neonatal cerebral infarction in full-term infants.  Arch Dis Child Fetal Neonatal Edition. 1997;  76 F88-F93
  PubMedGoogle Scholar
• 12 Golomb M R, Dick P T, MacGregor D L, Armstrong D C, DeVeber G A. Cranial ultrasonography has a low sensitivity for detecting arterial ischemic stroke in term neonates.  J Child Neurol. 2003;  18 98-103
  PubMedGoogle Scholar
• 13 Govaert P, Matthys E, Zecic A. et al . Perinatal cortical infarction within middle cerebral artery trunks.  Arch Dis Child Fetal Neonatal Edition. 2000;  82 F59-F63
  PubMedGoogle Scholar
• 14 Griffiths R. The abilities of babies: A Study in Mental Measurement. Amersham; Association of Research in Infant and Child Development 1976
  Google Scholar
• 15 Inoue Y, Matsumara Y, Fukuda T, Nemoto Y, Shirahata N, Suzuki T. et al . MR imaging of Wallerian degeneration in the brainstem: temporal relationships.  AJNR Am J Neuroradiol. 1990;  11 897-902
  PubMedGoogle Scholar
• 16 Kang D W, Chu K, Yoon B W, Song I C, Chang K H, Roh J K. Diffusion-weighted imaging in Wallerian degeneration.  J Neurol Sci. 2000;  178 167-169
  CrossrefPubMedGoogle Scholar
• 17 Krishnamoorthy K, Soman T, Takeoka M, Schaefer P. Diffusion-weighted imaging in neonatal cerebral infarction: clinical utility and follow-up.  J Child Neurol. 2000;  15 592-602
  PubMedGoogle Scholar
• 18 Kuhn M J, Johnson K A, Davis K R. Wallerian degeneration: evaluation with MR imaging.  Radiology. 1988;  168 199-202
  PubMedGoogle Scholar
• 19 Kuhn M J, Mikulis J, Ayoub D M, Kosofsky B E, Davis K R, Traveras J M. Wallerian degeneration after cerebral infarction: evaluation with sequential MR imaging.  Radiology. 1989;  172 179-182
  PubMedGoogle Scholar
• 20 Kűker W, Mohrle S, Mader I, Schoning M, Nagele T. MRI for the management of neonatal cerebral infarctions: importance of timing.  Childs Nerv System. 2004;  46 896-899
  PubMedGoogle Scholar
• 21 Ludwin S K, Bisby M A. Delayed Wallerian degeneration in the central nervous system of Ola mice: an ultrastructural study.  J Neurol Sci. 1992;  109 140-147
  CrossrefPubMedGoogle Scholar
• 22 Lynch J K, Hirtz D G, DeVeber G, Nelson K B. Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke.  Pediatrics. 2002;  109 116-123
  CrossrefPubMedGoogle Scholar
• 23 Mazumdar A, Mukherjee P, Miller J H, Malde H, McKinstry R C. Diffusion-weighted imaging in acute corticospinal tract injury preceding Wallerian degeneration in the maturing human brain.  AJNR Am J Neuroradiol. 2003;  24 1057-1066
  PubMedGoogle Scholar
• 24 McKinstry R C, Miller J H, Snyder A Z, Mathur A, Schefft G L, Almli C R. et al . A prospective, longitudinal diffusion tensor imaging study of brain injury in newborns.  Neurology. 2002;  59 824-833
  CrossrefPubMedGoogle Scholar
• 25 Mercuri E, Rutherford M, Cowan F, Pennock J, Counsell S, Papadimitriou M. et al . Early prognostic indicators of outcome in infants with neonatal cerebral infarction: a clinical, electroencephalographic and magnetic resonance imaging study.  Pediatrics. 1999;  103 39-46
  CrossrefPubMedGoogle Scholar
• 26 Mercuri E, Cowan F, Gupte G, Manning R, Laffan M, Rutherford M. et al . Prothrombotic disorders and abnormal neurodevelopmental outcome in infants with neonatal cerebral infarction.  Pediatrics. 2001;  107 1400-1404
  CrossrefPubMedGoogle Scholar
• 27 Mercuri E, Barnett A, Rutherford M, Guzzetta A, Haataja L, Cioni G. et al . Neonatal cerebral infarction and neuromotor outcome at school age.  Pediatrics. 2004;  113 95-100
  CrossrefPubMedGoogle Scholar
• 28 Merzbacher L. Untersuchungen an winterschlafenden Fledermäusen: II. Mittheilung. Die Nervendegeneration während des Winterschlafes. Die Beziehungen zwischen Temperatur and Winterschlaf [Investigations on hibernating bats. 2nd communication. The relationship between temperature and hibernation].  Arch Ges Physiol Menschen Thiere. 1903;  100 568-585
  PubMedGoogle Scholar
• 29 Nelson K B, Lynch J K. Stroke in new-born infants.  Lancet Neurology. 2004;  3 150-158
  CrossrefPubMedGoogle Scholar
• 30 Pennock J M, Rutherford M A, Cowan M, Bydder G M. MRI: early onset of changes in Wallerian degeneration.  Clin Radiol. 1993;  47 311-314
  PubMedGoogle Scholar
• 31 Ramaswamy V, Miller S P, Barkovich A J, Partridge J C, Ferriero D M. Perinatal stroke in term infants with neonatal encephalopathy.  Neurology. 2004;  62 2088-2091
  PubMedGoogle Scholar
• 32 Roelants-van Rijn A M, Nikkels P GJ, Groenendaal F, van der Grond J, Barth P G, Snoeck I. et al . Neonatal diffusion-weighted MR imaging: relation with histopathology or follow-up MR examination.  Neuropediatrics. 2001;  32 286-294
  Article in Thieme ConnectPubMedGoogle Scholar
• 33 Rutherford M, Counsell S, Allsop J, Boardman J, Kapellou O, Larkman D. et al . Diffusion-weighted magnetic resonance imaging in term perinatal brain injury: a comparison with site of lesion and time from birth.  Pediatrics. 2004;  114 1004-1014
  CrossrefPubMedGoogle Scholar
• 34 Touwen B LC. Examination of the Child with Minor Neurological Dysfunction. Clinics in Developmental Medicine. No 71. London; SIMP/Heineman 1979
  Google Scholar
• 35 Uchino A, Imada H, Ohno M. MR imaging of Wallerian degeneration in the human brain stem after ictus.  Neuroradiology. 1990;  32 191-195
  CrossrefPubMedGoogle Scholar
• 36 Uchino A, Sawada A, Takase Y, Egashira R, Kudo S. Transient detection of early Wallerian degeneration on diffusion-weighted MRI after an acute cerebrovascular accident.  Neuroradiology. 2004;  46 183-188
  CrossrefPubMedGoogle Scholar
• 37 Van der Toorn A, Dijkhuizen R M, Tulleken C A, Nicolay K. Diffusion of metabolites in normal and ischemic rat brain measured by localized 1 H MRS.  Magn Reson Med. 1996;  35 914-922
  PubMedGoogle Scholar
• 38 Van Everdingen K J, van der Grond J, Kappelle L J, Ramos L MP, Mali W PTM. Diffusion-weighted magnetic resonance imaging in acute stroke.  Stroke. 1998;  29 1783-1790
  CrossrefPubMedGoogle Scholar
• 39 Waller A V. Experiments on the section of the glosso-pharyngeal and hyoglossal nerves in the frog and observations of the alterations produced thereby in the structure of their primitive fibres.  Philosophical Transactions of the Royal Society London. 1850;  140 423-429
  PubMedGoogle Scholar

Prof. Dr. Linda S. de Vries

Department of Neonatology
Wilhelmina Children's Hospital
UMC Utrecht

KE 04.123.1

PO Box 85090

3508 AB Utrecht

The Netherlands

Email: l.devries@wkz.azu.nl