ICNC Abstracts, ICNC 2018

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Utility of Testing for Prothrombotic Disorders in Children with Perinatal Periventricular Venous Infarction
Noa Mandel-Shorer, Daune MacGregor, Suzanne Laughlin, Leonardo Brandao, Gabrielle deVeber, Nomazulu Dlamini, mahendranath moharir

Last modified: 2018-09-09

Abstract


BACKGROUND: In addition to perinatal arterial ischemic stroke (PAIS), perinatal periventricular venous infarction (PPVI) is increasingly recognized as a distinct subset of perinatal ischemic stroke (PIS) causing hemiplegic cerebral palsy following term birth. Recent population-based data suggest low yield of prothrombotic testing in PIS. Literature regarding prothrombotic testing in PPVI is scarce.

OBJECTIVES: To determine 1) frequency of prothrombotic abnormalities and 2) their impact on recurrent thromboembolism in children with PPVI.

METHODS: Retrospective review (1994-2014) of PIS cases in the Pediatric Stroke Registry at the Hospital for Sick Children, Toronto was conducted. Cases were ascertained based on published strict definitions by blinded re-review of MRIs by DM and MM (final adjudication by SL). Prothrombotic testing included protein C, protein S, antithrombin, lipoprotein(a), homocysteine, Factor-VII, lupus anticoagulant, anticardiolipin antibody, Factor-V Leiden and prothrombin gene mutations. Descriptive statistics were applied.

RESULTS: Among 143 PIS cases, 18(13%) PPVI cases were identified (11 males). 17/18 had prothrombotic testing [mean age at testing: 5y(range:2-13y)]. 4/17(23%) had abnormalities [3 FVL, 1 lipoprotein(a)]. 3/18(17%) had family history of thrombophilia. No recurrent thromboembolism occurred until last follow-up [mean age: 8.5y(range:3-17y)] in any patient w/wo prothrombotic abnormalities or positive family history. Neurological deficit severity did not differ between those w/wo prothrombotic abnormalities.

CONCLUSIONS: Although nearly 1 in 4 children with PPVI had a prothrombotic abnormality identified, this was not associated with recurrent thromboembolism or worse clinical outcome. Additional studies to investigate association of thrombophilia and PPVI are essential.


Keywords


perinatal venous stroke, thrombophilia

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