Twenty-two children with cerebral infarction on neonatal MRI were examined neurologically at school age in a study at Imperial College School of Medicine, Hammersmith, London, UK. Six (30%) had hemiplegia and an additional 7 (30%) had neuromotor abnormalities, including asymmetries. The remaining 9 had normal motor function. Hemiplegia occurred only in patients showing neonatal MRI evidence of hemisphere, internal capsule, and basal ganglia involvement. [1]
COMMENT. In children suffering a neonatal cerebral infarction, signs of neuromotor impairment become more obvious at school age when the neurologic examination is more structured.
Risk of recurrent stroke in children and antiphospholipid screening are reviewed from the University of California, San Francisco [2, 3]. Lanthier et al found no difference in recurrence rates between the anticardiolipin antibody (aCL)-positive and aCL-negative groups, when 185 children with a first arterial ischemic stroke or TIA were followed for a median of 3 years. However, aCL-positive children were more likely to be treated with antithrombotic agent, and treated patients were less likely to have a recurrence. In the absence of a prospective randomized trial, screening for antiphospholipid syndrome (APS) should continue as a routine component of the evaluation of arterial ischemic stroke and risk of recurrence.
Subsequent publication of the results of the antiphospholipid antibodies and stroke study (APASS), a prospective double-blind cohort study involving 1770 participants from multiple US clinical sites [4], concludes that the presence of aCL in patients with ischemic stroke does not predict an increased risk of subsequent stroke. Routine screening for aPL in patients with ischemic stroke may not be warranted. The debate continues.