Table 3

Trunkal middle cerebral artery infarction

Case NoGestational ageClinical detailsSiteOutcome
Entire posterior trunk of the middle cerebral artery
136PROM for 3 days, congenital pneumonia due to early onset group B streptococcal infection, shockLeftMild hemisyndrome
239Vacuum extraction, cephalhaematoma, focal seizures on day 1, early onset enterobacter septicaemia, no shockLeftNo sequelae
338Second twin, cord prolapse, difficult vacuum delivery, subgaleal bleeding, basal subdural haematoma, focal EEG changesLeftMild hemisyndrome
440PROM for 3 days, vacuum delivery, Apgar scores 4/6, general seizures on day 1, day 1 Hb 10.2 g/dl, metabolic acidosisLeftMild hemisyndrome, speech difficulties
5 (fig 1)37Twin, left renal vein thrombosis and adrenal haemorrhage, apc resistanceRightNo sequelae
638Breech delivery, focal seizures on day 2LeftOne epileptic insult at 3 months, no hemisyndrome
733Caesarean section for fetal distress superimposed on growth retardation; no IRDS; APC resistance; early cystic stage of the haemorrhagic infarction on day 1LeftNo follow up
Entire anterior trunk of the middle cerebral artery
8 (fig2)34IUGR, lost beat to beat variation, brief postnatal acidosis (the area involved span the right frontal and part of the parietal lobe's convexity, including rolandic cortex)RightSevere hemiplegia, MDI 84
940Focal seizures on day 2, APC resistance in propositus and asymptomatic father (presentation was with a right frontal lobe haematoma; the evolution showed this to be infarction with late neonatal regression with multiple cysts)RightNormal at 12 months, right predominance
Within part of the anterior trunk of the middle cerebral artery
1030Death of co-twin at 26 weeks, IRDS (the affected vessel was probably a branch of the prefrontal artery)RightUnknown
1138Second day seizures in a healthy infantLeftUnknown
1238Coarctation aorta, oesophageal atresia; systemic acidosis (haemorrhagic leucomalacia and right anterior middle cerebral artery infarction were associated in this child)RightUnknown
1340Oligohydramnios and stunted fetal growth for 2 weeks, chronic fetomaternal transfusion (Kleihauer-Betke 6%), focal seizures on day 2 (the area involved may have been within the prefrontal and precentral branches of the middle cerebral artery or may have been a watershed zone with the anterior cerebral artery)RightNormal at 12 months
  • Key: PROM = Premature rupture of membrane; IRDS = Idiopathic respiratory distress syndrome; APC = Activated protein C resistance (factor V Leiden).