Katsumi Hayakawa MD, Presenter: Nothing to Disclose

Shoko Yoshida MD, Abstract Co-Author: Nothing to Disclose

Yuriko Yamori MD, Abstract Co-Author: Nothing to Disclose

Toyoko Kanda MD, Abstract Co-Author: Nothing to Disclose

Nahoko Yoshida MD, Abstract Co-Author: Nothing to Disclose

Hiroyo Hirota MD, Abstract Co-Author: Nothing to Disclose

Mika Iwami MD, Abstract Co-Author: Nothing to Disclose

The presumed perinatal ischemic stroke (PPIS) is defined as a child presenting with pathological early hand preference and /or seizure, and normal neonatal period at least 2 months of age with chronic, focal infarction on neuroimaging. Among PPIS, antenatal periventricular venous infarction (PVI) may cause congenital hemiplegia in term-born children. The purpose of this study is to evaluate the clinical and neuroimaging features of these hemiplegic children and to compare them with the other hemiplegic groups.

The subjects consisted of six male and seven female patients who were diagnosed PVI based on clinical history and MRI findings. Their ages at MR exam ranged from 9 month to 27 years old (mean age=7.7 years). The clinical inclusion criteria were 1) term-born and normal perinatal period, 2) presentation with early hand preference and/or seizure, 3) remote ischemic stroke on neuroimaging. Imaging criteria of PVI were at least four of following findings; 1) focal periventricular white matter encephalomalacia, 2) T2 prolongation in posterior limb of internal capsule, 3) spared cerebral cortex, 4) hemosiderin deposition, 5) spared basal ganglia. The characteristics in clinical and MRI findings of the PVI group were evaluated in comparison with the other subtypes of spastic hemiplegia, including MCA infarction (MCA) (N=8) and malformation (Mal) (N=8).

The significant difference in clinical findings in PVI group were lower rate of mental retardation (p=0.0001) (15% vs 75% in MCA and 100% in Mal), lower rate of epilepsy (p=0.000) (8% vs 62% in MCA and 87% in Mal) and earlier walking age (p =0.01) (57% before 15 months of age vs 14% in MCA and 0% in Mal). The hand functions among three groups were not significantly different. The significant difference in MR findings for PVI group were lower rate of cerebral hemiatrophy (p=0.000)(0% vs 75% in MCA and Mal), lower rate of corpus callosum atrophy (p=0.001)(77% vs 87% in MCA and 25% in Mal) and lower rate of brainstem hemiatrophy (p=0.01)(30% vs 87% in MCA and Mal).

The functional prognosis of congenital hemiplegic children of PVI group is more favorable in comparison with those of other subtypes of hemiplegia.

It is important for radiologists to be familiar with the clinical and MRI features of PVI because these children had normal neonatal period and present with the early hand preference and/or seizure.

Hayakawa, K, Yoshida, S, Yamori, Y, Kanda, T, Yoshida, N, Hirota, H, Iwami, M, Clinical and MR Features of Periventricular Venous Infarction as a Cause of Congenital Spastic Hemiplegia.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034401.html