TABLE 3

Diagnosis of IPS

Diagnostic TechniquesMeritsLimitationsComments
Neuroimaging
    Cranial ultrasoundPortable; readily available; may identify stroke lesionsMay be insensitive in the first 1–4 d and may miss extremely posterior and anterior stroke lesionsUseful as a screening tool, especially in preterm infants
    CT scanRelatively quick and easy to performPoor definition of stroke lesions; posterior fossa lesions may be missed; cannot identify myelin; radiation hazard; not good for prognosticationConsider if acute symptoms indicate a surgically treatable condition
For diagnosis of sinovenous thrombosis, plain CT is inadequate; contrast CT is better
    CT venographyExcellent diagnostic accuracy for sinovenous thrombosisConsider when sinovenous thrombosis is suspected or magnetic resonance venography is equivocal
    MRIOptimal for diagnosis; defines lesion type; useful for determining etiology and for prognosticationSlow; requires transportation to MRI center; potential for motion artifact; expensive; requires knowledge of appropriate sequencesConsider as part of complete evaluation of IPS
    DWIGood for timing of the lesionNeeds to be performed early in neonatal periodConsider as part of complete evaluation of IPS
    Magnetic resonance angiographyHelps delineate vascular abnormalitiesNeeds sequence optimization; turbulent, slow flow wrongly suggests stenosis or “no flow”Consider when sinovenous thrombosis is suspected
    Magnetic resonance venographyHelps delineate sinovenous thrombosisTurbulent, slow flow wrongly suggests thrombotic occlusion
Autopsy and pathologic tests
    Placenta and umbilical cord examinationAvailabilityNeeds expertiseConsider as a requisite examination for evaluation of IPS
    Complete autopsy including evaluation of brain, heart malformation, systemic and cerebral arterial and venous structuresDefinitive procedure to establish cerebral ischemic lesion; helpful in exploring for inherited coagulation and thrombotic disordersNeed specialized expertise to perform perinatal autopsy and neuropathologic examination; lack of consent a limiting factorSpare no effort to obtain autopsy consent; consider collaborative efforts to establish the diagnosis and the underlying cause of IPS