Risk factors, coagulation profiles, and outcomes in 22 children with presumed perinatal infarct were studied at The Hospital for Sick Children, Toronto, and Chedoke McMaster Hospital, Hamilton, both participants in the Canadian Pediatric Ischemic Stroke Registry. Criteria for inclusion were the following: 1) normal neonatal neurological history, 2) hemiparesis and/or seizures first recognized after two months of age, and 3) CT or MRI showing remote cerebral infarct. Median age at presentation was 6 months. Median age at last visit was 4 years (range, 8 months to 16.5 years). Eighteen of 22 mothers had gestational or obstetrical risk factors, including preeclampsia (4), maternal infection (4), gestational diabetes (3), premature delivery, bleeding, and breech presentation. Fourteen children had coagulation abnormalities including anticardiolipin antibody (ACLA) in 12, and activated protein C resistance (APCR) in 3. Six had a family history of thrombosis. Echocardiograms were normal. Hemiparesis, right sided in 14, persisted in all patients, 12 had speech, behavior, or learning problems, and 5 had persistent seizures. Stroke did not recur, despite persistence of ACLA or other clotting abnormalities. [1]
COMMENT. ACLA is a risk factor for ischemic stroke in the fetus and neonate, and recognition of hemiparesis may be delayed to age 6 months or later.