Perinatal arterial ischemic stroke - Is amplitude integrated EEG a helpful tool for the clinician?

BACKGROUND

Clinical symptoms of perinatal arterial ischemic stroke (PAIS) are subtle and include mostly seizures, apneas or focal neurologic deficits thus diagnosis is easily delayed or missed. PAIS is reliably diagnosed by magnetic resonance imaging (MRI) showing focal infarction in an arterial vascular territory.

PATIENTS: We included 6 neonates with diagnosis of PAIS to the cohort of our study.

METHODS

We investigated amplitude-integrated electroencephalography (aEEG) of six infants with PAIS as a potential tool for the clinician to facilitate early diagnosis of PAIS in this retrospective descriptive study.

RESULTS

Two infants had an infarction of the right middle cerebral artery and four of the left middle cerebral artery. All infants were monitored with aEEG due to suspected seizure activity and showed unilateral electrographic seizure activity, suggesting PAIS. Cerebral MRI confirmed PAIS over the affected hemisphere.

DISCUSSION: Unilateral seizures, asymmetric background pattern and abnormal sleep wake cycles over one hemisphere have been found in patients with PAIS. Infants with unilateral abnormalities should receive cerebral MRI to diagnose or rule out PAIS. Furthermore, the aEEG can be used to observe therapeutic success of anticonvulsant therapy.

CONCLUSION

In neonates with clinical seizures, aEEG provides valuable information for diagnosis of PAIS by revealing unilateral seizure patterns. It may facilitate early suspicion and prompt MRI evaluation.