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With an incidence up to 63 per 100,000 live births, perinatal stroke is an important cause of childhood epilepsy. The aim of the study was to find the prevalence of and predictive factors for epilepsy, and to describe the course of epilepsy in children with perinatal stroke with different vascular subtypes. Patients were retrieved from the Estonian Paediatric Stroke Database with follow-up time at least 24 months. Patients were divided into 5 perinatal stroke syndromes: neonatal arterial ischemic stroke (AIS), neonatal hemorrhagic stroke, neonatal cerebral sinovenous thrombosis, presumed AIS, and presumed periventricular venous infarction. The final study group included 73 children with perinatal stroke (39 boys). With a median follow-up time of 8.6 years, epilepsy was diagnosed in 21/73 (29%) children, most of whom had AIS (17/21, 81%). The 18-year cumulative poststroke epilepsy risk according to the Kaplan-Meier estimator was 40.8% (95% confidence interval [CI] 20.7-55.9%). The median age at epilepsy diagnosis was 50 months (range 1 month to 18.4 years). Children with neonatal AIS had the highest risk of epilepsy, but children with presumed AIS more often had severe epilepsy syndromes. Cortical lesions (odds ratio [OR] 19.7, 95% CI 2.9-133), and involvement of thalamus (OR 9.8, 95% CI 1.8-53.5) and temporal lobe (OR 8.3, 95% CI 1.8-39.6) were independently associated with poststroke epilepsy. The risk for poststroke epilepsy after perinatal stroke depends on the vascular subtype. Patients with perinatal AIS need close follow-up to detect epilepsy and start with antiepileptic treatment on time.

Objective: To determine the frequency, risk factors and the outcomes of a perinatal stroke. Study Design: Cross-sectional study. Place and Duration of Study: Neonatal Intensive Care Unit, Department of Pediatrics, Aga Khan University Hospital, Karachi Pakistan, from Jan to Dec 2019. Methodology: Neonates with perinatal stroke confirmed on the neuroimaging, were included in the study. The primary outcomes were risk factors, divided into 3 groups, maternal, placental and neonatal. The secondary outcome was the condition at the time of the discharge. Results: A total of 58 patients were included in the study. Maternal risk factors identified in the study, were intrauterine infections 10 (17.2%), anti-phospholipid syndrome, gestational diabetes 8 (13.8%) and preeclampsia 7 (12.1%). Chorioamnionitis 9 (15.5%), antepartum hemorrhage 6 (10.3%), and placenta previa 4 (6.9%) were the placental risk factors. Neonatal risk factors were birth asphyxia 35 (60.3%), sepsis/meningitis 8 (13.8%), premature birth 6 (10.3%) and fetal bradycardia 4 (6.9%). Resuscitation was needed in 35 (60.3%) neonates with birth asphyxia. Haemorrhagic stroke was observed in 38 (65.5%) cases, ischemic stroke in 14 (24.1%) cases and mixed type of stroke was found in 6 (10.3%) patients. The total mortality rate in our study was13.8%. Conclusion: Haemorrhagic stroke was more common than ischemic or mixed stroke among the patients of perinatal stroke at our healthcare facility. Patients with low APGAR score at 5 minutes, birth asphyxia and male gender, were most affected.

Perinatal stroke is a vascular injury occurring early in life, often resulting in motor deficits (hemiplegic cerebral palsy/HCP). Comorbidities may also include poor neuropsychological outcomes, such as deficits in memory. Previous studies have used resting state functional MRI (fMRI) to demonstrate that functional connectivity (FC) within hippocampal circuits is associated with memory function in typically developing controls (TDC) and in adults after stroke, but this is unexplored in perinatal stroke. Investigating links with visual memory function has the potential to inform prognosis and personalized cognitive rehabilitation strategies. This study aimed to quantify FC within hippocampal circuits of children and adolescents with perinatal stroke and associations with visual memory. We hypothesized that FC would differ between participant groups (AIS, PVI, TDC) and hemispheres (left vs. right stroke), and would correlate with visual memory function. Participants aged 6–19 years with HCP and MRI‐confirmed unilateral perinatal stroke (n = 30) arterial ischemic stroke (AIS), n = 38 periventricular venous infarction (PVI) were recruited through the Alberta Perinatal Stroke Project and compared to n = 43 TDC. Resting fMRI volumes (150 volumes, TR/TE = 2000/30 ms, voxels 3.6 mm isotropic, 36 axial slices) were processed to compute FC values between memory‐related seeds (including bilateral hippocampi) using a standard pipeline in the CONN toolbox. Seed‐to‐voxel and seed‐to‐seed analyses computed FC with each hippocampus. Hemispheric and group differences in FC were examined. A subset of stroke participants (n = 46) completed visual memory testing via CNS Vital Signs (CNSVS), a computerized neurocognitive test battery. Partial correlations assessed associations between FC and visual memory function, factoring out age. We found hemispheric differences in FC within each group. Participants with left perinatal stroke showed greater FC between the hippocampus and lateral prefrontal cortex in the lesioned compared to non‐lesioned hemisphere. TDCs had higher hippocampal FC when compared to the lesioned hemisphere of stroke groups. For participants with right hemisphere stroke, associations were observed between hippocampal FC and visual memory function. We describe differences in bilateral hippocampal functional connectivity in children and adolescents with perinatal stroke that are associated with visual memory function. Our findings suggest that developmental plasticity may occur in the non‐lesioned hippocampus after perinatal stroke. These findings may inform our understanding of how visual memory function is affected after early unilateral brain injury and facilitate the development of novel therapies for individuals affected by perinatal stroke. This study investigated the functional connectivity of hippocampal networks in children with perinatal stroke. Results revealed that functional connectivity in hippocampal circuits is altered in children with perinatal stroke compared to typically developing peers, and there is an association between hippocampal network connectivity and visual memory function in stroke‐affected groups.

•EEG functional networks after perinatal stroke are more clustered, less modular and have high interhemispheric strength.•Children after perinatal stroke have lower intelligence, poorer visual-motor integration abilities and attention deficits.•Modularity of functional brain networks correlates positively with IQ and processing speed.•Higher network segregation and stronger functional connectivity correlate with a tendency to impulsive decision making. Mechanisms underlying cognitive impairment after perinatal stroke could be explained through brain network alterations. With aim to explore this connection, we conducted a matched test-control study to find a correlation between functional brain network properties and cognitive functions in children after perinatal stroke. First, we analyzed resting-state functional connectomes in the alpha frequency band from a 64-channel resting state EEG in 24 children with a history of perinatal stroke (12 with neonatal arterial ischemic stroke and 12 with neonatal hemorrhagic stroke) and compared them to the functional connectomes of 24 healthy controls. Next, all participants underwent cognitive evaluation. We analyzed the differences in functional brain network properties and cognitive abilities between groups and studied the correlation between network characteristics and specific cognitive functions. Functional brain networks after perinatal stroke had lower modularity, higher clustering coefficient, higher interhemispheric strength, higher characteristic path length and higher small world index. Modularity correlated positively with the IQ and processing speed, while clustering coefficient correlated negatively with IQ. Graph metrics, reflecting network segregation (clustering coefficient and small world index) correlated positively with a tendency to impulsive decision making, which also correlated positively with graph metrics, reflecting stronger functional connectivity (characteristic path length and interhemispheric strength). Our study suggests that specific cognitive functions correlate with different brain network properties and that functional network characteristics after perinatal stroke reflect poorer cognitive functioning.

Background Stroke among younger age groups is increasing globally. While there is a focus on research conducted on people under 65 years who have had a stroke, there is a paucity of data on the incidence and risk factors of stroke among younger people (≤ 30 years). This scoping review examines evidence on incidence and risk factors for perinatal, paediatric and young adult stroke globally. Methods The review was guided by the Joanna Briggs Institute’s scoping review methodology. A systematic search was conducted on 23rd March 2022 across Medline Ovid, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The eligibility criteria included all study designs providing information on the incidence and risk factors of stroke among young people (≤ 30 years) in the last ten years. Results A total of 5750 articles were identified. After screening, 471 articles (224 cohort studies (47.6%), 164 case studies/case series (34.8%), 35 reviews (7.4%), 30 case-control (6.4%) and 18 combinations of designs (3.8%) were included. There was data from 50 different countries, 199 studies were from high-income countries, upper and middle income ( n  = 38), lower middle-income ( n  = 39), low-income ( n  = 3) countries, international study ( n  = 7) and a further 185 articles did not state the country of research. Most of the studies (63%) focused on risk factors while incidence constituted 37%. Incidence data were reported heterogeneously across studies, leading to an inability to synthesise data. The three most frequently reported risk factors for perinatal stroke were infections, cardiac conditions, and intrapartum factors. Vasculopathies, infection and cardiac conditions accounted for most reported risk factors for paediatric stroke, while chronic conditions such as diabetes mellitus, vasculopathies and cardiac conditions accounted for the most reported risk factors among young adults. Conclusion This review has highlighted different stroke risk factors for each age cohort of people under 30 years. The low number of epidemiological studies suggests that further research of this type is needed to fully understand the incidence and risk factors in young stroke. A standardised reporting of age groupings of incidence data is imperative to enable the comparison of data from different geographical locations.

Periventricular venous infarction (PVI) is a subtype of perinatal stroke localized to subcortical white matter occurring before 34 weeks of gestation. An emerging body of literature has reported life-long motor impairments and compromised quality of life in patients with PVI. However, there remains a paucity of foundational knowledge regarding the underlying neurobiological mechanisms that underpin these outcomes. Recent studies (Ferradal et al. in Cereb Cortex 29:1218–1229, 2019) in brain imaging suggest that healthy development of thalamocortical connections is instrumental in coordinating brain connectivity in both prenatal and postnatal periods given the central role the thalamus and basal ganglia play in motor circuitry. Therefore, we provide a regional and cross-network approach to the analysis of interactive pathways of the thalamus, basal ganglia, and cortex to explore possible neurobiological disruptions responsible for clinical motor function in children with PVI. A resting-state fMRI protocol was administered to children with left periventricular venous infarction (PVI) (n = 23) and typically developing children (TDC) (n = 22) to characterize regional oscillatory and thalamocortical disturbances and compare them to clinical motor function. We hypothesized that PVI would affect resting-state measures of both regional and global brain function, marked by abnormally high amplitudes of regional oscillatory activity, as well as lower local and cross-network communication. Using a combination of robust functional metrics to assess spontaneous, oscillatory activity (Amplitude of Low-Frequency Fluctuations [ALFF] and fractional ALFF), as well as local (Regional Homogeneity [ReHo]) and cross-network connectivity (Degree Centrality [DC] and Functional Connectivity [FC]). We found that compared with TDC, children with PVI exhibited higher levels of ALFF, and these functional differences were associated with the severity of motor impairment. Moreover, the thalamus in children with PVI also showed lower connectivity in relaying thalamocortical pathways. These disruptions in thalamocortical pathways from the thalamus were localized to the medial prefrontal cortex (mPFC), a key hub of the default mode network). Collectively, our findings suggest that heightened levels of regional, oscillatory activity in the thalamus may disrupt more widespread thalamocortical cross-network circuity, possibly contributing to motor impairments in children with PVI.

Introduction: Perinatal stroke is a rare but clinically significant condition that can present in a variety of ways, which can result in diagnostic challenges in a particularly vulnerable population. We present the case of a term neonate who presented with left arm swelling, ultimately diagnosed with perinatal stroke. Case Report: A term male neonate presented to the emergency department with left arm swelling noted the day prior, with abnormal tone of the left arm since birth. Physical examination revealed mild erythema and edema localized to the left upper extremity, with the arm held in flexion. Neurological examination was otherwise unremarkable. Further evaluation, including imaging studies, demonstrated thrombi in the left axillary and subclavian arteries, as well as an infarct involving the right middle cerebral artery (MCA) and anterior cerebral artery (ACA) with diffusion restriction, consistent with perinatal stroke. Conclusion: Through this case report, we aim to increase awareness of perinatal stroke among healthcare professionals and highlight the importance of prompt recognition and appropriate management in optimizing outcomes for affected infants.

Pediatric stroke, a significant cause of long-term neurological deficits in children, often arises from disruptions within neurovascular unit (NVU) components. The NVU, a dynamic ensemble of astrocytes, endothelial cells, pericytes, and microglia, is vital for maintaining cerebral homeostasis and regulating vascular brain development. Its structural integrity, particularly at the blood–brain barrier (BBB), depends on intercellular junctions and the basement membrane, which together restrict paracellular transport and shield the brain from systemic insults. Dysfunction in this intricate system is increasingly linked to pediatric stroke and related cerebrovascular conditions. Mutations disrupting endothelial cell adhesion or pericyte–endothelial interactions can compromise BBB stability, leading to pathological outcomes such as intraventricular hemorrhage in the germinal matrix, a hallmark of vascular brain immaturity. Additionally, inflammation, ferroptosis, necroptosis, and autophagy are key cellular processes influencing brain damage and repair. Excessive activation of these mechanisms can exacerbate NVU injury, whereas targeted therapeutic modulation offers potential pathways to mitigate damage and support recovery. This review explores the cellular and molecular mechanisms underlying NVU dysfunction, BBB disruption, and subsequent brain injury in pediatric stroke. Understanding the interplay between genetic mutations, environmental stressors, and NVU dynamics provides new insights into stroke pathogenesis. The susceptibility of the germinal matrix to vascular rupture further emphasizes the critical role of NVU integrity in early brain development. Targeting inflammatory pathways and cell death mechanisms presents promising strategies to preserve NVU function and improve outcomes for affected neonates.

Perinatal stroke (PS), occurring between 20 weeks of gestation and 28 days of life, is a leading cause of hemiplegic cerebral palsy (HCP). Hallmarks of HCP are motor and sensory impairments on one side of the body—especially the arm and hand contralateral to the stroke (involved side). HCP is diagnosed months or years after the original brain injury. One effective early intervention for this population is constraint-induced movement therapy (CIMT), where the uninvolved arm is constrained by a mitt or cast, and therapeutic activities are performed with the involved arm. In this preliminary investigation, we used 3D motion capture to measure the spatiotemporal characteristics of pre-reaching upper extremity movements and any changes that occurred when constraint was applied in a real-time laboratory simulation. Participants were N = 14 full-term infants: N = six infants with typical development; and N = eight infants with PS (N = three infants with PS were later diagnosed with cerebral palsy (CP)) followed longitudinally from 2 to 6 months of age. We aimed to evaluate the feasibility of using 3D motion capture to identify the differences in the spatiotemporal characteristics of the pre-reaching upper extremity movements between the diagnosis group, involved versus uninvolved side, and with versus and without constraint applied in real time. This would be an excellent application of wearable sensors, allowing some of these measurements to be taken in a clinical or home setting.

This study aimed to investigate the influence of prothrombotic risk factors on long-term outcomes of patients with perinatal arterial ischemic stroke. The study was conducted through an analysis of monitoring results that were regularly maintained for approximately 20 years at a tertiary stroke-monitoring center. The study assessed prothrombotic risk factors, radiological area of involvement, clinical presentation, treatments, clinical outcomes, and long-term outcomes of the 48 patients included in the study, with a mean monitoring time of 77.6 ± 45.7 months (range: 6-204). Our results showed that the presence of prothrombotic risk factors did not affect long-term outcomes. However, patients with middle cerebral artery infarction had the highest risk of developing cerebral palsy, whereas those with presumed stroke had the highest risk of developing epilepsy. This study suggests that prothrombotic risk factors should not be evaluated during the acute stage unless there is a strong suspicion of the patient's history, and prevention or early diagnosis of presumed stroke patients will positively impact their long-term prognosis.