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(Stroke. 2009;40:2402.)
© 2009 American Heart Association, Inc.

Original Contributions

Predictive Value of Clinical and EEG Features in the Diagnosis of Stroke and Hypoxic Ischemic Encephalopathy in Neonates With Seizures

Mubeen F. Rafay, MB, BS; Miguel A. Cortez, MD; Gabrielle A. deVeber, MD; Cherrie Tan-Dy, MD; Amna Al-Futaisi, MD; Woojin Yoon, BSc; Shafagh Fallah, PhD Aideen M. Moore, MD

From the Section of Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Winnipeg; the Program in Brain & Behavior (M.A.C.), the Division of Neurology, Department of Pediatrics (M.A.C., G.A.d.V., A.A.-F.), the Population Health Sciences Program (G.A.d.V., W.Y., A.M.M.), and the Division of Neonatology, Department of Pediatrics (C.T.-D., S.F., A.M.M.), The Hospital for Sick Children, Toronto, Ontario, Canada.

Correspondence to Mubeen F. Rafay, Section of Neurology, Department of Pediatrics and Child Health, Winnipeg Children’s Hospital, Room AE 308, 820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9. E-mail mrafay{at}exchange.hsc.mb.ca

Background and Purpose— In neonates, the differentiation of stroke and hypoxic ischemic encephalopathy (HIE) is important. Neuroimaging presents technical challenges in unstable neonates, resulting in frequently delayed or missed diagnosis of stroke. Differentiating clinical and electroencephalographic (EEG) features would assist physicians in the timely diagnosis. We sought to determine, in neonates with seizures, clinical and EEG features that differentiate stroke and HIE.

Methods— Retrospective cohort study comparing clinical, seizure, and EEG features in term neonates with ischemic stroke or HIE and seizures within 7 days after birth, admitted at The Hospital for Sick Children. Putative clinical and EEG predictors of stroke were analyzed with univariate and multivariate methods.

Results— Sixty-two newborns with stroke (n=27) or HIE (n=35) were studied. With univariate analysis, predictors of stroke included delayed seizure onset (12-hours after birth) (P<0.0001; OR, 26.4; 95% CI, 6.8, 102.5), focal motor seizures (P=0.001; OR, 7.2; 95% CI, 2.0, 26.0) and pattern of neurological abnormalities (P<0.0001). With multivariate analysis, delayed seizure onset (P<0.0001; OR 39.7; 95% CI, 7.3, 217.0) and focal motor seizures (P=0.007; OR, 13.4; 95% CI, 2.1, 87.9) predicted stroke. Presence of both predictors had 100% positive predictive value and specificity, 61% negative predictive value and 37% sensitivity.

Conclusions— In neonates, onset of seizures beyond 12 hours of birth and clinically observed focal seizures are predictive of stroke. These preinvestigation indicators of stroke may facilitate earlier diagnosis and institution of specific management strategies.

Key Words: acute care • EEG • hypoxix ischemic encephelopathy • predictors of diagnosis • cereberal infarction • neonates