Presumed pre- or perinatal arterial ischemic stroke: Risk factors and outcomes

A subgroup of children with arterial ischemic stroke in the pre- or perinat al period present with delayed diagnosis. We identified 22 children who met the following criteria: (1) normal neonatal neurological history, (2) hemi paresis and/or seizures first recognized after two months of age, and (3) c omputed tomography or magnetic resonance imaging showing remote cerebral in farct. Laboratory evaluations included protein C, protein S, antithrombin, activated protein C resistance screen (APCR), Factor V Leiden (FVL), prothr ombin gene defect, methylene tetrahydrofolate reductase variant (MTHFR), an ticardiolipin antibody (ACLA), and lupus anticoagulant. Not all children re ceived all tests. Age at last visit ranged from 8 months to 16.5 years (med ian 4 years). Twelve were boys. Fourteen had left hemisphere infarcts. Medi an age at presentation was 6 months. Eighteen had gestational complications . Fourteen children had at least transient coagulation abnormalities (ACLA = 11, ACLA + APCR = 1, APCR = 2 with FVL + MTHFR = 1); six of these childre n had family histories suggestive of thrombosis. Cardiac echocardiogram. wa s unremarkable in the 15 tested. Outcomes included persistent hemiparesis i n 22; speech, behavior, or learning problems in 12; and persistent seizures in five, with no evidence of further stroke in any patient. The persistenc e and importance of coagulation abnormalities in this group need further st udy.