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PEDIATRICS Vol. 103 No. 1 January 1999, pp. 39-46

Early Prognostic Indicators of Outcome in Infants With Neonatal Cerebral Infarction: A Clinical, Electroencephalogram, and Magnetic Resonance Imaging Study

Received Mar 27, 1998; accepted Jun 30, 1998.

Eugenio Mercuri*, Mary Rutherford*, Dagger , Frances Cowan*, Jackie PennockDagger , Serena CounsellDagger , Maria Papadimitriou*, Denis Azzopardi*, Graeme BydderDagger , and Lilly Dubowitz*

From the * Department of Paediatrics, Dagger  Robert Steiner MRI Unit, Hammersmith Hospital, Imperial College, London, United Kingdom.

Objective.  The aim of this study was to identify prognostic factors in newborns with cerebral infarction.

Design.  Antenatal and perinatal factors and early clinical, electroencephalogram (EEG), and magnetic resonance imaging (MRI) findings were compared with neurodevelopmental outcome in 24 children with evidence of cerebral infarction on neonatal MRI.

Results.  Out of 24 infants, 19 had an infarction in the territory of a major cerebral vessel and 5 in the borderzone between cerebral arteries. Neuromotor outcome was normal in 17 and abnormal in 7 infants. Of these 7 infants, 5 infants showed a definite hemiplegia, whereas the other 2 showed some asymmetry of tone or function but no definite hemiplegia.None of the adverse antenatal or perinatal factors was significantly associated with abnormal outcome. Neonatal clinical examination was also not always predictive of the outcome. The extent of the lesion on MRI was a better predictor. In particular, it was the concomitant involvement of hemisphere, internal capsule and basal ganglia that was always associated with an abnormal outcome whereas the involvement of only one or two of the three tended to be associated with a normal outcome.EEG was also very helpful. Abnormal background activity either unilateral or bilateral was found in 6 infants and 5 out of 6 developed hemiplegia. In contrast, the presence of seizure activity in presence of a normal background was not related to abnormal outcome.

Conclusions.  Early MRI and EEG can help to identify the infants with cerebral infarction who are likely to develop hemiplegia.  Key words:  newborn, cerebral infarction, brain, neurological examination, magnetic resonance imaging, electroencephalogram.




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