OBJECTIVE: To determine whether clinical presentations and risk factor profiles differ between periventricular venous infarction (PVI) and arterial presumed perinatal ischemic stroke (APPIS). DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 59 children with presumed perinatal ischemic stroke (PPIS) from the SickKids Children's Stroke Program who were carried to term (63% boys). SETTING: Single tertiary care center subspecialty program. INTERVENTIONS: Participants had validated magnetic resonance imaging classification to define PVI and APPIS subgroups. MAIN OUTCOME MEASURES: Clinical presentations, times to parental and physician concern, age at diagnosis, and standardized risk factor evaluations including maternal, fetal, obstetrical, neonatal, and prothrombotic variables. Patients with PVI and APPIS were compared using chi(2) or Fisher exact tests and Wilcoxon rank sum or Mann-Whitney U tests. RESULTS: A total of 12 children (20%) had PVI and 47 (80%) had APPIS. Median parental concern was 5 months, with delays to physician concern (7 months) and diagnosis (12 months). Delays were longer in PVI cases compared with APPIS (P = .002). Most presented with asymmetrical motor development but children with APPIS were more likely to present with seizures or nonmotor delays (P = .01). Children with APPIS were more likely to have acute perinatal risk factors (66% vs 17%; P = .002) including fetal distress, emergency caesarian section, or neonatal resuscitation. Cardiac evaluations were unremarkable. Prothrombotic abnormalities were common (44%) including protein S deficiency, lupus anticoagulant, and elevated factor IX but were comparable between APPIS and PVI subgroups. CONCLUSIONS: Diagnosis of PPIS is often delayed. The association of acute perinatal risk factors with APPIS compared with PVI supports distinct timing of these diseases. Prospective, case-control risk factor studies of PPIS subtypes are required to develop prevention strategies.
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机译：目的:确定临床演示文稿和危险因素资料有所不同室旁静脉梗塞(元太)之间和动脉围产期缺血性中风(美国)。参与者:一共有59的孩子假定围产期缺血性中风(质子泵抑制剂)SickKids儿童中风程序的人学期男生(63%)。三级医疗中心附属专业项目。干预措施:参与者验证磁共振成像的分类定义元太和美国子组。措施:临床表现,乘以父母和医生担忧,诊断、年龄和标准化的风险因素评估包括孕产妇、胎儿、产科、新生儿和凝血变量。和美国相比使用气(2)或费舍尔准确的测试和Wilcoxon或Mann-Whitney排名你的测试。元太,47(80%)美国。关心的是5个月,医生延误关注(7个月)和诊断(12个月)。拖延是时间在此情况下,与之相比美国(P = .002)。不对称的运动发育,但儿童美国人更有可能与癫痫发作或nonmotor延迟(P = . 01)。更有可能有急性围产期风险因素(66% vs 17%;遇险,紧急剖腹产手术,或新生儿复苏。不起眼的。常见(44%),包括蛋白质不足,狼疮抗凝剂,但第九凝血因子升高比较美国和元太子组之间。结论:质子泵抑制剂的诊断常常是延迟。协会的急性围产期高危因素与美国相比,元太支持截然不同这些疾病的时机。质子泵抑制剂亚型病例对照风险因素的研究需要制定预防策略。
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