Neuroimaging and Neurological Outcomes in Perinatal Arterial Ischemic Stroke: A Systematic Review and Meta-Analysis

AimPrediction of outcomes in perinatal arterial ischemic stroke (PAIS) is challenging. We performed a systematic review and meta-analysis to determine whether infarct characteristics can predict outcomes in PAIS.MethodA systematic search was conducted using 5 databases in January 2023. Studies were included if: the sample included children with neonatal or presumed perinatal arterial ischemic stroke, if infarct size, location, or laterality was indicated, and at least one motor, cognitive, or language outcome were reported. The level of evidence and risk of bias were evaluated using the ROBINS-I tool. Meta-analyses were conducted comparing infarct size or location with neurological outcomes when at least 3 studies could be analyzed.ResultsEighteen full-text articles were included in a systematic review and of those, 9 were included in meta-analysis. Meta-analyses revealed that small strokes were associated with a lower risk of cerebral palsy/hemiplegia compared to large strokes (risk ratio (RR)=0.263, p=0.001) and a lower risk of epilepsy (RR=0.182, p<0.001). Middle cerebral artery (MCA) infarcts were not associated with a significantly different risk of cerebral palsy/hemiplegia compared to non-MCA strokes (RR=1.220, p=0.337). Bilateral infarcts were associated with a 48% risk of cerebral palsy/hemiplegia, a 26% risk of epilepsy, and a 58% risk of cognitive impairment.InterpretationLarger stroke size was associated with worse outcomes across multiple domains. Widely heterogeneous reporting of infarct characteristics and outcomes limits the comparison of studies and the analysis of outcomes. More consistent reporting of infarct characteristics and outcomes will be important to advance research in this field.