Advances in perinatal stroke: From early prediction to future therapies

Abstract

Imaging and continuous monitoring of the brain, as well as clinical movement assessment of the upper limbs, are tools to accurately predict future development, already within the first days to weeks after a perinatal stroke. This enables clinicians to early identify infants at risk for an adverse outcome, who are most likely to benefit from new early intervention strategies in the near future. This thesis describes research about the consequences of perinatal stroke on long term neurological development. Infants with perinatal stroke are at high risk of developmental disorders, such as cerebral palsy, learning and behavioral problems, and epilepsy. Early risk evaluation of these consequences is important in order to adequately inform parents and caregivers, and to start intervention programs as soon as possible. In the first week after presentation, MR imaging and continuous monitoring of brain activity and cerebral oxygenation provide accurate prediction parameters on future motor and cognitive development. At three months of age, asymmetry in the quality and quantity of upper limb movement is highly predictive of unilateral cerebral palsy. Infants at high risk of unfavorable development may benefit most from (new) early intervention strategies. This thesis provides an overview of several new treatment strategies, such as neurotrophic growth factors and stem cells, and the final steps required to bring these therapies into clinical practice.