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Bedside neurophysiological tests can identify neonates with stroke leading to cerebral palsy |
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| Affiliation: | 1. Division of Developmental and Behavioral Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA;2. Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel;3. The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel;4. Department of English Literature and Linguistics, Bar Ilan University, Ramat Gan, Israel;1. The University of Queensland, Centre for Clinical Research, St Lucia, Brisbane, Australia;2. The University of Queensland, Centre for Medical Diagnostic Technologies in Queensland, St Lucia, Brisbane, Australia;3. The University of Queensland, Discipline of Medical Imaging, St Lucia, Brisbane, Australia;4. The University of Queensland, School of Medicine, St Lucia, Brisbane, Australia;5. Department of Radiation Oncology, Royal Brisbane and Women''s Hospital, Herston, Brisbane, Australia;6. Specialised PET Services Queensland, Royal Brisbane and Women''s Hospital, Herston, Brisbane, Australia;7. The Australian e-Health Research Centre, CSIRO, Royal Brisbane and Women''s Hospital, Herston, Brisbane, Australia;8. Department of Medical Imaging, Royal Brisbane and Women''s Hospital, Herston, Brisbane, Australia |
| Abstract: | ObjectiveThe unspecific symptoms of neonatal stroke still challenge its bedside diagnosis. We studied the accuracy of routine electroencephalography (EEG) and simultaneously recorded somatosensory evoked potentials (EEG-SEP) for diagnosis and outcome prediction of neonatal stroke.MethodsWe evaluated EEG and EEG-SEPs from a hospital cohort of 174 near-term neonates with suspected seizures or encephalopathy, 32 of whom were diagnosed with acute ischemic or hemorrhagic stroke in MRI. EEG was scored for background activity and seizures. SEPs were classified as present or absent. Developmental outcome of stroke survivors was evaluated from medical records at 8- to 18-months age.ResultsThe combination of continuous EEG and uni- or bilaterally absent SEP (n = 10) was exclusively seen in neonates with a middle cerebral artery (MCA) stroke (specificity 100%). Moreover, 80% of the neonates with this finding developed with cerebral palsy. Bilaterally present SEPs did not exclude stroke, but predicted favorable neuromotor outcome in stroke survivors (positive predictive value 95%).ConclusionsAbsent SEP combined with continuous EEG background in near-term neonates indicates an MCA stroke and a high risk for cerebral palsy.SignificanceEEG-SEP offers a bedside method for diagnostic screening and a reliable prediction of neuromotor outcome in neonates suspected of having a stroke. |
| Keywords: | Neonatal stroke Electroencephalography (EEG) Somatosensory evoked potentials (SEP) Neonatal seizures Neonatal intensive care Cerebral palsy (CP) AT"} {"#name":"keyword" "$":{"id":"k0040"} "$$":[{"#name":"text" "_":"anterior trunk AIS"} {"#name":"keyword" "$":{"id":"k0050"} "$$":[{"#name":"text" "_":"arterial ischemic stroke BE"} {"#name":"keyword" "$":{"id":"k0060"} "$$":[{"#name":"text" "_":"base excess CP"} {"#name":"keyword" "$":{"id":"k0070"} "$$":[{"#name":"text" "_":"cerebral palsy DM1"} {"#name":"keyword" "$":{"id":"k0080"} "$$":[{"#name":"text" "_":"distal M1 branch of the MCA EEG"} {"#name":"keyword" "$":{"id":"k0090"} "$$":[{"#name":"text" "_":"electroencephalography HIE"} {"#name":"keyword" "$":{"id":"k0100"} "$$":[{"#name":"text" "_":"hypoxic-ischemic encephalopathy ICH"} {"#name":"keyword" "$":{"id":"k0110"} "$$":[{"#name":"text" "_":"intracerebral hemorrhage IVH"} {"#name":"keyword" "$":{"id":"k0120"} "$$":[{"#name":"text" "_":"intraventricular hemorrhage SEP"} {"#name":"keyword" "$":{"id":"k0130"} "$$":[{"#name":"text" "_":"somatosensory evoked potential MRI"} {"#name":"keyword" "$":{"id":"k0140"} "$$":[{"#name":"text" "_":"magnetic resonance imaging MCA"} {"#name":"keyword" "$":{"id":"k0150"} "$$":[{"#name":"text" "_":"middle cerebral artery NPV"} {"#name":"keyword" "$":{"id":"k0160"} "$$":[{"#name":"text" "_":"negative predictive value PVI"} {"#name":"keyword" "$":{"id":"k0170"} "$$":[{"#name":"text" "_":"periventricular venous infarction PPV"} {"#name":"keyword" "$":{"id":"k0180"} "$$":[{"#name":"text" "_":"positive predictive value PT"} {"#name":"keyword" "$":{"id":"k0190"} "$$":[{"#name":"text" "_":"posterior trunk PM1"} {"#name":"keyword" "$":{"id":"k0200"} "$$":[{"#name":"text" "_":"proximal M1 branch of the MCA |
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