European Journal of Pediatrics

, Volume 152, Issue 12, pp 1030–1035 | Cite as

Results of parenchymal and angiographic magnetic resonance imaging and neuropsychological testing of children after stroke as neonates

  • W. Koelfen
  • M. Freund
  • S. König
  • V. Varnholt
  • H. Rohr
  • Ch. Schultze


We describe the long-term follow up of infants after neonatal stroke of the middle cerebral artery (MCA). Stroke was diagnosed by CT scan in eight full-term neonates. Three dimensional (volume) magnetic resonance angiography (MRA) is a noninvasive technique that images the arterial vessels without contrast agents. All patients, aged from 1.5 to 8.4 years, were investigated by MRI and MRA and by neuropsychological tests. Cognitive development was investigated by intelligence tests, tests of visual perception, motor and language development. Out of the eight patients, seven had a retarded mental and motor development, and 50% of the children were treated for epilepsy. Seven patients had a spastic hemiparesis. Seven out of eight children showed major cognitive deficits. In all patients, MRI revealed clear parenchymal defects with variable distribution patterns. MRA studies showed abnormalities corresponding to the expected vascular distribution. Children with complications at delivery, with seizures, and an interruption of the main stem of MCA as demonstrated on MRA had the least favourable long-term follow up prognosis with severe cognitive delays.

Key words

Neonatal stroke Magnetic resonance imaging Magnetic resonance angiography Neuropsychological tests Long-term follow up 



middle cerebral artery


magnetic resonance angiography


magnetic resonance imaging


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Allan WC, Philip AGS (1985) Neonatal cerebral pathology diagnosed by ultrasound. Clin Perinatol 12:195–217PubMedGoogle Scholar
  2. 2.
    Anderson CM, Saloner D, Tsuruda JS, et al (1990) Artifacts in maximum-intensity-projection display of MR angiograms. AJR 154:623–629PubMedGoogle Scholar
  3. 3.
    Barmada MA, Mossy J, Schumann RM (1979) Cerebral infarcts with arterial occlusion in neonates. Ann Neurol 6:495–502CrossRefPubMedGoogle Scholar
  4. 4.
    Clancy RR, Malin S, Laraque D, et al (1985) Pocal motor seizures heralding stroke in fullterm neonates. Am J Dis Child 139:601–606PubMedGoogle Scholar
  5. 5.
    Gibo H, Carver CP, Rhoton AL, et al (1981) Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54:151–167PubMedGoogle Scholar
  6. 6.
    Hankey GJ, Warlow CP, Sellar RJ (1990 Cerebral angiographic risk in mild cerebrovascular disease. Stroke 21:209–222PubMedGoogle Scholar
  7. 7.
    Hill A., Martin DJ, Daneman A, et al (1983) Focal ischemic cerebral injury in the newborn diagnosis by ultrasound and correlation with computed tomographic scan. Pediatrics 71:790–793PubMedGoogle Scholar
  8. 8.
    Klesh W, Murphy T, Scher M, Buchanan D (1987) Cerebral in-farction im persistent pulmonary hypertension of the newborn. AJOC 141:852–857Google Scholar
  9. 9.
    Levy SR, Abroms IF, Marshall PC, et al (1985) Seizures and cerebral infarction in the fullterm newborn. Ann Neurol 17:366–370CrossRefPubMedGoogle Scholar
  10. 10.
    Mannino FL, Trauner DA (1983) Stroke in neonates. J Pediatr 102:605–610PubMedGoogle Scholar
  11. 11.
    Mantovani JF, Gerber GJ (1984) “Idiopathic” neonatal cerebral infarction. Am J Dis Child 138:359–362PubMedGoogle Scholar
  12. 12.
    Ment LR, Duncan CC, Ehrenkranz RA (1984) Perinatal cerebral infarction. Ann Neurol 165:559–568CrossRefGoogle Scholar
  13. 13.
    Mohr JP, Duterte DI, Oliveira VR, et al (1988) Recanalization of acute middle cerebral artery occlusion. Neurology 38:215Google Scholar
  14. 14.
    Roodhooft AM, Parizel PM, Von Acker KJ, et al (1987) Idiopathic cerebral arterial infarction with paucity of symptoms in the full-term neonate. Pediatrics 80:381–385PubMedGoogle Scholar
  15. 15.
    Sacco RL, Mohr JP, Hauser WA (1989) Predictors of one year outcome in 30-day survivors of cerebral infraction. Ann Neurol 26:157Google Scholar
  16. 16.
    Tomsick TA, Brott TG, Chambers AA, et al (1990) Hyperdense middle cerebral artery sign on CT: efficacy in detecting middle cerebral artery thrombosis. AJNR 11:473–477PubMedGoogle Scholar
  17. 17.
    Trauner D, Mannino F (1986) Neurodevelopmental outcome after neonatal cerebrovascular accident. J Pediatrics 108:459–461Google Scholar
  18. 18.
    Uvebrant P (1988) Hemiplegic cerebral palsy: aetiology and outcome. Acta Pediatr Scand [Suppl] 345:1–100Google Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • W. Koelfen
    • 1
  • M. Freund
    • 2
  • S. König
    • 1
  • V. Varnholt
    • 1
  • H. Rohr
    • 1
  • Ch. Schultze
    • 1
  1. 1.Department of Pediatrics, Faculty of Clinical Medicine MannheimUniversity of HeidelbergMannheimGermany
  2. 2.Department of Radiology, Faculty of Clinical Medicine MannheimUniversity of HeidelbergMannheimGermany

Personalised recommendations