Perinatal cortical infarction within middle cerebral artery trunks

Aim-To define neonatal pial middle cerebral artery infarction. Methods-A retrospective study was made of neonates in whom focal arterial i nfarction had been detected ultrasonographically. A detailed study was made of cortical middle cerebral artery infarction subtypes. Results-Forty infarctions, with the exception of those in a posterior cereb ral artery, were detected ultrasonograghically over a period of 10 years. M ost were confirmed by computed tomography or magnetic resonance imaging. Fa ctor V Leiden heterozygosity was documented in three. The onset was probabl y antepartum in three, and associated with fetal distress before labour in one. There were 19 cases of cortical middle cerebral artery stroke. The tru ncal type (n=13) was more common than complete (n = 5) middle cerebral arte ry infarction. Of six infarcts in the anterior trunk, four were in term inf ants and five affected the right hemisphere. Clinical seizures were part of the anterior truncal presentation in three. One of these infants, with inv olvement of the primary motor area, developed a severe motor hemisyndrome. The Bayley Mental Developmental Index was above 80 in all of three infants tested with anterior truncal infarction. Of seven patients with posterior t runcal infarction, six were at or near term. Six of these lesions were left sided. Clinical seizures were observed in three. A mild motor hemisyndrome developed in at least three of these infants due to involvement of parieto -temporal nonprimary cortex. Conclusions-Inability to differentiate between truncal and complete middle cerebral artery stroke is one of the explanations for the reported differen t outcomes. Severe motor hemisyndrome can be predicted from neonatal ultras onography on the basis of primary motor cortex involvement. Clinical seizur es were recognised in less than half of the patients with truncal infarctio n; left sided presentation was present in the posterior, but not the anteri or truncal type of infarction. Asphyxia is a rare cause of focal arterial i nfarction.