Abstracts

Rationale: Perinatal arterial stroke (PAS) is a focal arterial infarction occurring between 20 weeks gestation and 28 days of age. Diagnosis of PAS in the newborn period usually occurs as part of an evaluation for neonatal seizures, and if often an unexpected finding. Seizures are the most common reason for neurological consultation in newborns. Although PAS occurs in 1 in 4000 neonates, it is not clear how often PAS accounts for seizures in the newborn period. Furthermore, few studies have systematically evaluated the EEG’s in these infants. Still many cases of PAS are diagnosed retrospectively when the child is older, usually when a hemiplegia is noted, such delay in therapy results in unnecessary morbidity. Therefore, it is of great importance that better diagnostic criteria be developed to diagnose PAS in timely fashion. The goal of this study was to determine the prevalence of PAS among infants presenting with seizures within first 7 days of life as well as describe clinical and electrographic characteristics of these seizures. Methods: We performed a retrospective chart review of patients hospitalized at Children’s Hospital of Wisconsin from 1/1/02 to 12/31/07. Charts were selected by query for discharge diagnosis using ICD 9 codes for both seizures and stroke as well as procedure codes for EEG. Charts of patients identified with seizures were reviewed for presence of PAS. Infants with gestational age < 28 weeks or seizure, PAS onset after 7 days of life, intracranial hemorrhage, cerebral venous sinus thrombosis, or border zone ischemia in the absence of PAS were excluded from the study. The EEGs of these infants were reviewed by a neonatal epileptologist who was blinded to clinical history. Results: Between 1/1/02 and 12/31/07 3407 newborns were admitted to the NICU at CHW. Among them we identified 90 infants who presented with seizures within the first 7 days of life, and 12 of whom (13%) were diagnosed with PAS. All 12 infants diagnosed with PAS presented with seizures, and 10/12 (83%) presented with seizures within 48 hours of life. All infants with PAS were term gestation (37 weeks or more), and 9/12 of the infants were male. 8 patients had focalilty to their clinical seizures, but of these, 7/8 had laterality consistent with their stroke. 11/12 patients with PAS had abnormal EEGs and all abnormal EEGs had focal findings correlating with the location of the stroke. Conclusions: 1.In infants admitted to a tertiary NICU, PAS accounts for 13% of seizures occurring in the first 7 days of life. 2.83% of the patients with PAS have seizures within the first 48hr of life. 3.Most PAS occurred in males and in the left anterior circulation. 4.EEG can be used to identify and localize focal cerebral dysfunction associated with PAS.