Mammillary body and hippocampal injury after acute perinatal arterial ischemic stroke

Lequin, Maarten, Baak, Lisanne M., Dudink, Jeroen, Vann, Seralynne ORCID: https://orcid.org/0000-0002-6709-8773, Groenendaal, Floris, de Vries, Linda S., Benders, Manon J.N.L., Nijboer, Cora H.A., Wagenaar, Nienke and van der Aa, Niek E. 2025. Mammillary body and hippocampal injury after acute perinatal arterial ischemic stroke. Neurology Open Access 1 (1) , e0004. 10.1212/wn9.0000000000000004

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Abstract

Background and Objectives Perinatal arterial ischemic stroke (PAIS) affects approximately 1–2 per 5,000 full-term births and can result in long-term neurologic changes such as hemiparesis, epilepsy, and cognitive impairments, including memory difficulties. The mammillary bodies (MBs) and the hippocampi (HCs) are both important brain structures for memory, and they are affected in infants with perinatal asphyxia, but less is known about their involvement in PAIS. We performed a retrospective study to determine the prevalence of MB and HC injury and to assess whether the injury varied according to the arterial territory involved and the co-occurrence of perinatal asphyxia. Methods This retrospective study assessed the status of the MB and HC of 130 neonates born between 2005 and 2023 diagnosed with acute PAIS based on neonatal MRI. Involvement of the MB and HC was based on diffusion-weighted imaging and T1/T2-weighted imaging. The hemisphere and arterial territory involved in the PAIS were documented along with clinical measures and the presence of perinatal asphyxia and therapeutic hypothermia. Results MRI scans were acquired at a median of 5 days after birth. Most of the strokes involved the middle cerebral artery. The MB could be assessed in 127 of 130 patients with PAIS and were found to be injured in 21 (16.5%) of 127, with equivocal signal change in a further 27 (21%) of 127 patients. MB injury occurred more often with larger strokes and was almost exclusively found bilaterally. MB injury was more prevalent when there was co-occurring perinatal asphyxia (odds ratio 3.56). Only 6% (8/130) of patients with PAIS showed HC injury, which was typically unilateral and located within the primary arterial stroke area. Discussion MB injury is frequently present in neonates with PAIS, while HC injury occurs less often. The MB and HC injuries seem to be caused by different processes, with the HC injury typically resulting from the direct impact of the stroke. Understanding the mechanisms through which the MBs become injured in PAIS, both with and without perinatal asphyxia, is an important future goal.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Psychology
Publisher:	Ovid Technologies (Wolters Kluwer Health)
Date of First Compliant Deposit:	17 January 2025
Date of Acceptance:	14 November 2024
Last Modified:	17 Jan 2025 13:15
URI:	https://orca.cardiff.ac.uk/id/eprint/175346

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