Bedside neurophysiological tests can identify neonates with stroke leading to cerebral palsy.
OBJECTIVE
The unspecific symptoms of neonatal stroke still challenge its bedside diagnosis. We studied the accuracy of routine electroencephalography (EEG) and simultaneously recorded somatosensory evoked potentials (EEG-SEP) for diagnosis and outcome prediction of neonatal stroke.


METHODS
We evaluated EEG and EEG-SEPs from a hospital cohort of 174 near-term neonates with suspected seizures or encephalopathy, 32 of whom were diagnosed with acute ischemic or hemorrhagic stroke in MRI. EEG was scored for background activity and seizures. SEPs were classified as present or absent. Developmental outcome of stroke survivors was evaluated from medical records at 8- to 18-months age.


RESULTS
The combination of continuous EEG and uni- or bilaterally absent SEP (n = 10) was exclusively seen in neonates with a middle cerebral artery (MCA) stroke (specificity 100%). Moreover, 80% of the neonates with this finding developed with cerebral palsy. Bilaterally present SEPs did not exclude stroke, but predicted favorable neuromotor outcome in stroke survivors (positive predictive value 95%).


CONCLUSIONS
Absent SEP combined with continuous EEG background in near-term neonates indicates an MCA stroke and a high risk for cerebral palsy.


SIGNIFICANCE
EEG-SEP offers a bedside method for diagnostic screening and a reliable prediction of neuromotor outcome in neonates suspected of having a stroke.
['Nevalainen|Päivi|P|', 'Metsäranta|Marjo|M|', 'Toiviainen-Salo|Sanna|S|', 'Lönnqvist|Tuula|T|', 'Vanhatalo|Sampsa|S|', 'Lauronen|Leena|L|']
D001921:Brain D002547:Cerebral Palsy D004569:Electroencephalography D005073:Evoked Potentials, Somatosensory D005260:Female D006801:Humans D007231:Infant, Newborn D008279:Magnetic Resonance Imaging D008297:Male D020521:Stroke
Neonatal stroke Electroencephalography (EEG) Cerebral palsy (CP) Neonatal intensive care Neonatal seizures Somatosensory evoked potentials (SEP)