Paeds Flashcards
5 common childhood cancers
5 foremost childhood cancers in South Africa are (registry statistics 2009-2013:
Leukaemia
Lymphoma
Brain tumours
Nephroblastoma/ tumour
Bone cancer/Soft tissue sarcoma
Cancer registry
Collect accurate and complete cancer data
that can be used for cancer control and epidemiological research, public health program planning, and patient care improvement.
Ultimately, these activitiesreduce the burden of cancer
St siluan early warning signs of childhood cancer (acronym)
S - seek help if there are symptoms
I - white spots in eye, squinting, bulging
L - lump in body parts
U - unexplained fever > 2 weeks, loss of weight, pallor, fatigue, bleeding or bruising
A - aching of bones, joints, back and fractures
N- Neurological signs (walking, balance, speech)
Most common acute leukaemia
Adult acute myeloid leukemia (AML) is a type of cancer in which the bone marrow makes a large number of abnormal blood cells. AML is a cancer of the blood and bone marrow. It is the most common type of acute leukemia in adults. This type of cancer usually gets worse quickly if it is not treated.1
Why do childhood cancers develop
Prenatal exposure to X-rays
Postnatal exposure to high doses of radiation (e.g. therapeutic radiation as previously used for conditions such as tinea capitis and thymus enlargement)
Previous treatment with chemotherapy
Genetic conditions; e.g Down syndrome and risk of leukaemia
Burkitt Lymphoma
an aggressive non-Hodgkin B-cell lymphoma. The disease is associated with Epstein Barr virus (EBV), human immunodeficiency virus (HIV), and chromosomal translocations that cause the overexpression of oncogene c-myc.
Burkitt Lymphoma
an aggressive non-Hodgkin B-cell lymphoma. The disease is associated with Epstein Barr virus (EBV), human immunodeficiency virus (HIV), and chromosomal translocations that cause the overexpression of oncogene c-myc.
Burkitt’s leukemia as opposed to lympjoma
Burkitt’s leukemia occurs when the bone marrow contains a certain level of Burkitt’s lymphoma cells.
Burkitt’s leukemia as opposed to lymphoma
Burkitt’s leukemia occurs when the bone marrow contains a certain level of Burkitt’s lymphoma cells.
Most common autoimmune condition in kids
Systemic lupus e - SLE
attacks your child’s body tissues, including the lungs, kidneys and skin
Most common renal tumour
Nephroblastoma - Wilm’s tumour
Wilm’s tumour symptoms
large flank mass, haematuria and hypertension
Hypertension is due to activation of RAS (renin release) and compression of renal vasculature due to tumor
About 10% of children with Wilms tumor have a congenital anomaly that predisposed them to its development
Hemihypertrophy - one side larger than the other
Urinary tract anomalies, including cryptorchidism and hypospadias
Beckwith Wiedeman syndrome
Examples of autosomal dominant disorders
Familial hypercholesterolaemia
Neurofibromatosis
Marfan’s syndrome
Achondroplasia
Coronary artery disease / atherosclerotic heart disease
Damage or disease in the heart’s major blood vessels.
The usual cause is the build-up of plaque. This causes coronary arteries to narrow, limiting blood flow to the heart.
Coronary artery disease can range from no symptoms, to chest pain, to a heart attack.
Familial hypercholestrolemoa describe and features
High levels of LDL
Mutations in the LDLR gene (>700 mutations)
Causes premature coronary artery disease
Heterozygous/homozygous forms
Founder effect- Afrikaner population
(1 in 100 individuals affected)
Neurofibromatosis type 1 - what’s the spots called
Cafe au lait
Ahcindroplasia
Skeletal dysplasia - short limbed dwarfism
Achondroplasia is a genetic condition affecting a protein in the body called the fibroblast growth factor receptor. In achondroplasia, this protein begins to function abnormally, slowing down the growth of bone in the cartilage of the growth plate.
Hemolysis
Hemolysis is the destruction or breakdown of red blood cells (erythrocytes). Seen in sickle cell anaemia
Hunter syndrome
syndrome is a rare genetic disorder in which your child’s body doesn’t properly break down (digest) certain sugar molecules. When these molecules build up in organs and tissues over time, they can cause damage that affects physical and mental development.
X linked recessive occurring in males
AMBULATION
Ambulation is the ability to walk from place to place independently, with or without assistive devices. Early walking is one of the most crucial things seniors can do after surgery to prevent postoperative complications.
Seen in Duchenne dystrophy
Huntington’s disease
An inherited condition in which nerve cells in the brain break down over time.
It typically starts in a person’s 30s or 40s.
Usually, Huntington’s disease results in progressive movement, thinking (cognitive) and psychiatric symptoms.
No cure exists, but drugs, physiotherapy and talk therapy can help manage some symptoms.
Spinocerebellar ataxias
Spinocerebellar ataxia (SCA) is a group of inherited brain disorders. It affects your cerebellum, a part of your brain vital to coordination of physical movement, and sometimes your spinal cord. This inherited condition worsens over time and causes specific problems with coordination, usually affecting: Eyes.
Myotonic dystrophy
Myotonic dystrophy is characterized by progressive muscle wasting and weakness. People with this disorder often have prolonged muscle contractions (myotonia) and are not able to relax certain muscles after use. For example, a person may have difficulty releasing their grip on a doorknob or handle.
Epigentic disorder with hyotonia
Prader-Willi syndrome (PWS) is characterized by severe hypotonia, poor appetite, and feeding difficulties in early infancy, followed in early childhood by excessive eating and gradual development of morbid obesity (unless food intake is strictly controlled). Motor milestones and language development are delayed.
Epigenetic disorder with hypoglycaemia
Beckwith-Wiedemann syndrome (BWS) is a congenital growth disorder, which means it’s present at birth. BWS has various signs and symptoms, including a large body size at birth and taller-than-average height during childhood, a large tongue, and hypoglycemia (low blood sugar).
Teratogenic drug with 50% risk and why
Isotretinoin (roaccutane) - can cause craniofaciak abnormalities
Disorder of alcohol teratogen
EFINITIONS:
FASD (fetal alcohol spectrum disorder):
A continuum of disabilities related to effects on developing brain
Alcohol related neurodevelopmental disorder (ARND),alcohol related birth defect (ARBD)
FAS (fetal alcohol syndrome):
Most severe end of the FASD spectrum
Has a characteristic pattern of dysmorphic features
Microcephaly
Microcephaly is a condition where a baby’s head is much smaller than expected. During pregnancy, a baby’s head grows because the baby’s brain grows. Microcephaly can occur because a baby’s brain has not developed properly during pregnancy or stopped growing after birth
Clinical manifestations of FASD
Microcephaly
Growth restriction
Dysmorphic features (short palpebral fissures), smooth philtrum and thin vermillion border
Limbs – radiolunar synostosis, clinodactyly
Cardiac defects (birth defects)
Behavioural/cognitive/learning difficulties
Radio ulnar synostosis
Radioulnar synostosis is a rare condition in which the two bones of the forearm — the radius and the ulna — are abnormally connected.
Hypoxaemia
Hypoxemia is low levels of oxygen in your blood. It causes symptoms like headac
What is a shunt
Short - an irregular pattern of blood low in your heart.
In cardiology, a cardiac shunt is a pattern of blood flow in the heart that deviates from the normal circuit of the circulatory system. It may be described as right-left, left-right or bidirectional, or as systemic-to-pulmonary or pulmonary-to-systemic.
a passage by which blood moves from one area (blood vessel or heart chamber) to another in a pattern that isn’t normal.
ASD
An atrial septal defect (ASD) is a heart condition that you’re born with between atria . That means it’s a congenital heart defect. People with an ASD have a hole between the upper heart chambers. The hole increases the amount of blood going through the lungs
Luckil6 not very common
As a baby develops in the womb, a wall (septum) forms that divides the upper chamber into a left and right atrium. When this wall does not form correctly, it can result in a defect that remains after birth. This is called an atrial septal defect, or ASD.
Causes
Normally, blood cannot flow between the two upper heart chambers. However, an ASD allows this to happen.
When blood flows between the two heart chambers, this is called a shunt. Blood most often flows from the left to the right side. When this happens the right side of the heart enlarges. Over time pressure in the lungs may build up. When this happens, the blood flowing through the defect will then go from right to left. If this occurs, there will be less oxygen in the blood that goes to the body.
Differences between secundum and primum septal defects
Atrial septal defects are defined as primum or secundum.
The primum defects are linked to other heart defects of the ventricular septum and mitral valve.
Secundum defects can be a single, small or large hole. They may also be more than one small hole in the septum or wall between the two chambers.
Sinus venous septal defect
A sinus venosus atrial septal defect is a type of atrial septal defect primarily associated with the sinus venosus. They represent 5% of atrial septal defects. They can occur near the superior vena cava or inferior vena cava, but the former are more common.
Sinus venous
The sinus venosus is a cardiac chamber upstream of the right atrium that harbours the dominant cardiac pacemaker. During human heart development, the sinus venosus becomes incorporated into the right atrium.
Effects of post tricuspid shunts
Post-tricuspid shunts lead to increased flow and pressure to the pulmonary vasculature up to systemic pressure levels, leading to a more rapid progression of abnormal pulmonary vascular remodeling, often early in childhood.
Effects of pre tricuspid shunts
Pre-tricuspid shunts are left-to-right (or bidirectional) shunts at a low-pressure level, which lead to volume load on the right ventricle (RV) and pulmonary circulation, without immediate or midterm increase of pulmonary arterial pressure (PAP).
PS murmur
Pulmonic stenosis (PS) is narrowing of the pulmonary outflow tract causing obstruction of blood flow from the right ventricle to the pulmonary artery during systole. Most cases are congenital; many remain asymptomatic until adulthood. Signs include a crescendo-decrescendo ejection murmur.
TS murmur
The murmur of tricuspid stenosis is mid-diastolic at the left lower sternal border (tricuspid listening post). Since venous return increases during inspiration, the murmur can be louder with this maneuver. This is different than Carvallo’s sign which occurs in the setting of tricuspid valve regurgitation.
Coarctation
A narrowing of the large blood vessel (aorta) that leads from the heart.
Coarctation of the aorta is usually present at birth (congenital) and may occur with other heart defects.
Many people have no symptoms and the condition often isn’t detected until adulthood. The most common symptom in adults is high blood pressure. Rarely, severe cases can cause heart failure in babies.
paO2
A PaO2 test measures partial pressure of oxygen, or PaO2—the oxygen pressure in arterial blood. The PaO2 reflects how well oxygen is able to move from the lungs to the blood.
paO2
A PaO2 test measures partial pressure of oxygen, or PaO2—the oxygen pressure in arterial blood. The PaO2 reflects how well oxygen is able to move from the lungs to the blood.
Asphyxia
a condition arising when the body is deprived of oxygen, causing unconsciousness or death; suffocation.
HIE
Hypoxic-Ischemic Encephalopathy (or HIE) is a non-specific term for brain dysfunction caused by a lack of blood flow and oxygen to the brain. Sometimes, HIE is also referred to as birth asphyxia, but this term only pertains to a very strict criteria of infants with brain injury.
3 causes in decreased blood flow in relation to cyanosis lesions
Tetralogy of Fallot
Pulmonary atresia
Tricuspid atresia
Tetralogy of Fallon - what is it and 4 defects
Tetralogy of Fallot (TOF) is a combination of four congenital (present at birth) heart defects that affect infants and children. The defects occur together and change the way blood flows through the heart and lungs. TOF occurs in about 1 out of every 2,518 babies born in the U.S. each year.
- overriding aorta (shifts to the right and sits about the VSD hole unlike a normal aorta which is the to left
- VSD
- Pulmonary stenosis
- RV hypertrophyb
Tricuspid atresia
Tricuspid atresia is a type of heart disease that is present at birth (congenital heart disease), in which the tricuspid heart valve is missing or abnormally developed. The defect blocks blood flow from the right atrium to the right ventricle. Other heart or vessel defects are usually present at the same time.
Risk factors for teratology of fallot
Male
1st degree family history of CHD
Teratogens
Genetic conditions
d-TGA
Dextro-transposition, or d-transposition, of the great arteries is a life-threatening heart birth defect that arises when the two “great” (or main) arteries within the heart are switched, or transposed, so that each one carries blood to the wrong location.
L-TGA
Levo-transposition of the great arteries (L-TGA) is when the positions of the heart’s ventricles are reversed. Some people with the condition never need treatment. Others develop symptoms and need treatment with medicines and surgery.
Pulmonary atresia
Pulmonary atresia is type of heart defect that a baby is born with. It occurs when the pulmonary valve — normally located between the right ventricle and the pulmonary artery — doesn’t form properly. This means that blood can’t flow from the heart to the lungs to get oxygen to the body.
What is the difference between pulmonary stenosis and atresia?
The term pulmonary stenosis refers to narrowing of the right ventricular outflow tract; pulmonary atresia implies complete occlusion of the right ventricular outflow tract.
Pathophysiology of pulmonary atresia
In pulmonary atresia, the valve leaflets are fused. This causes a solid sheet of tissue to form where the valve opening should be. Normal blood flow to the lung is blocked as a result. Because of this defect, blood from the right side of the heart is restricted from reaching the lungs to pick up oxygen.
Pathophysiology of ToF
Pathophysiology depends on the degree of right ventricular outflow obstruction. A mild obstruction may result in a net left-to-right shunt through the VSD; a severe obstruction causes a right-to-left shunt, resulting in low systemic arterial saturation (cyanosis) that is unresponsive to supplemental oxygen.
Hypoxia Tet Spells or hypercyanotic spells
Some babies with tetralogy of Fallot suddenly develop deep blue or gray skin, nails, and lips. This usually happens when the baby cries, eats or is upset. These episodes are called tet spells.
Tet spells are caused by a rapid drop in the amount of oxygen in the blood. They are most common in young infants, around 2 to 4 months old. Tet spells may be less noticeable in toddlers and older children. That’s because they typically squat when they’re short of breath. Squatting sends more blood to the lungs.
Longer explanation:
In some children with unrepaired tetralogy of Fallot, most often those several months up to 2 years of age, sudden episodes of profound cyanosis and hypoxia (hypercyanotic or “tet” spells) may occur, which may be lethal. A spell may be triggered by any event that slightly decreases oxygen saturation (eg, crying, defecating) or that suddenly decreases systemic vascular resistance (eg, playing, kicking legs when awakening) or by sudden onset of tachycardia or hypovolemia.
The mechanism of a hypercyanotic spell remains uncertain, but several factors are probably important in causing an increase in right-to-left shunting and a fall in arterial oxygen saturation. Factors include
An increase in right ventricular outflow tract obstruction
An increase in pulmonary vascular resistance
A decrease in systemic resistance
These factors lead to a vicious circle caused by the initial fall in arterial PO2, which stimulates the respiratory center and causes hyperpnea and increased adrenergic tone. The increased circulating catecholamines then stimulate increased contractility, which increases outflow tract obstruction.
Pathophysiology of tricuspid atresia
Tricuspid atresia is a cyanotic congenital heart defect characterized by the complete agenesis of the tricuspid valve. Consequently, the absence of communication between the right atrium and the ventricle leads to cyanosis.
Truncus arteriosis
Truncus arteriosus (common truncus) occurs when a single common blood vessel comes from the heart, instead of the usual two vessels. A baby with this condition may need surgery or other procedures soon after birth. Therefore, this defect is considered a critical congenital heart defect (critical CHD).
Clinical manifestations of TGA
TGA symptoms usually appear in the first hours or days after birth. Babies may exhibit: Cyanosis (bluish skin, lips and nails from not getting enough oxygen-rich blood) Fast or labored breathing.
Clinical manifestations of pulmonary atresia
Symptoms of pulmonary atresia often appear within the first few hours or days of a baby’s life and may include: Rapid breathing. A bluish tinge to the skin, especially the lips, fingers and toes. Cool, pale or clammy skin.
Clinical manifestations of tricuspid atresia
Clinical manifestations of pulmonary stenosis
Common symptoms of pulmonic stenosis include: Chest pain: You may feel discomfort in your lungs and chest. Shortness of breath: Breathing normally may feel difficult, especially during physical activity. Fainting: You may lose consciousness or feel dizzy.
Pathophysiology of persistent pulmonary HPT
Persistent pulmonary hypertension occurs due to failure of normal transition from intrauterine circulation. It is characterized by persistently elevated pulmonary vascular resistance (PVR), resulting in decreased pulmonary blood flow (PBF).3
Longer:
Persistent pulmonary hypertension of the newborn is the persistence of or reversion to pulmonary arteriolar constriction, causing a severe reduction in pulmonary blood flow and right-to-left shunting at the atrial and/or ductal level. Symptoms and signs include tachypnea, retractions, and severe cyanosis or desaturation unresponsive to oxygen.
In normal fetal circulation, blood entering the right side of the heart has already been oxygenated via the placenta. Because the lungs are not ventilated, only a small amount of blood needs to go through the pulmonary artery. Most blood from the right side of the heart bypasses the lungs through the foramen ovale and ductus arteriosus. Normally, these two structures close shortly after birth. (See also Neonatal Cardiovascular Function.)
In PPHN (previously known as persistent fetal circulation), prenatal stress, postnatal stress, and anatomical differences may result in the persistence of elevated pulmonary vascular resistance after birth. Hypoxemia and acidosis cause the pulmonary arterioles to constrict and the ductus arteriosus to dilate, reversing the usual processes establishing newborn circulation at delivery and resulting in right-to-left shunting through the ductus arteriosus, foramen ovale, or both. This right-to-left shunting bypasses the lungs and causes nonoxygenated or poorly oxygenated blood to be delivered systemically.
The most common causes of persistent pulmonary hypertension of the newborn involve
Perinatal asphyxia or hypoxia
A history of meconium staining of amniotic fluid or meconium in the trachea is common. Hypoxia triggers reversion to or persistence of elevated pulmonary vascular resistance, a normal state in the fetus.
Additional cause of PPHPT
Additional causes include
Respiratory distress syndrome
Premature ductus arteriosus or foramen ovale closure, which increases fetal pulmonary blood flow and may be triggered by maternal nonsteroidal anti-inflammatory drug (NSAID) use (1)
Pulmonary hypoplasia with associated pulmonary vasculature hypoplasia leading to PPHN (2)
Congenital diaphragmatic hernia, in which one lung is severely hypoplastic, also leading to pulmonary vasculature hypoplasia and PPHN
Neonatal sepsis or neonatal pneumonia presumably because vasoconstrictive prostaglandins are produced by activation of the cyclooxygenase pathway by bacterial phospholipids, and acidosis due to systemic hypoperfusion caused by the infection also contributes to PPHN in this scenario
Clinical manifestations of persistent pulmonary HPT
Breathing problems such as rapid or slow breathing, grunting and retracting.
Rapid heart rate.
Bluish color to your baby’s skin (cyanosis).
Low blood pressure (hypotension).
Low blood oxygen levels.
Extra or abnormal heart sounds (heart murmur).
TAPVD
Total anomalous pulmonary venous drainage (TAPVD) is a rare congenital (present at birth) heart defect whereby the pulmonary veins carrying the oxygen-rich (red) blood from the lungs do not connect to the left side of the heart (left atrium). In a normal heart, the four pulmonary connect directly into the heart’s left atrium, enabling the heart to pump the oxygen-rich (red) blood out to the body.
With TAPVD, the pulmonary veins instead, are connected to one of the veins in the main circulation, carrying oxygen-poor (blue) blood and returning to the right side of the heart. This means the red blood simply circles to and from the lungs and never gets out to the body.
Oral conmensals
The oral cavity harbors an average of 300 to 500 different bacterial species, including Staphylococcus aureus, Haemophilus influenzae, Neisseria meningitides, Streptococcus pneumoniae, Veillonella, Actinomyces, Fusobacterium, Porphyromonas, Prevotella, Capnocytophaga, Lactobacterium, and Peptostreptococcus [3]
Saccular aneurysm
Berry (or saccular) aneurysms are the most common type of intracranial aneurysm, representing 90% of cerebral aneurysms. Generally speaking, ballooning arises from a weakened area in the wall of a blood vessel in the brain.
Ectasia
The term “ectasia” refers to diffuse dilation of a coronary artery, while focal coronary dilation is called a “coronary aneurysm.”[1] The definition of coronary artery ectasia is a dilatation exceeding more than one-third of the coronary artery length with the diameter of the dilated segment measuring more than 1.5 ..
Strider vs wheezing
Stridor is a higher-pitched noisy that occurs with obstruction in or just below the voice box. Determination of whether stridor occurs during inspiration, expiration, or both helps to define the level of obstruction. Wheezing is a high-pitched noise that occurs during expiration in the lower resp airways
Recession of lungs / respiratory retractions
Sign of respiratory distress that occurs when chest wall indraws
Happens when body has to work harder to breathe in air
Singed hair
Hair that has been lightly burned or shrivelled using a little paper or other device
Trismus
When your jaws become so tight you can’t open your mouth
ALTC criup
Acute Laryngotracheobronchitis (ALTB) is a viral infection of the throat (upper airway). The virus causes swelling of the voice box (larynx) and windpipe (trachea). The swelling narrows the airway and makes breathing hard.
Pulses paradoxus
Pulsus paradoxus refers to an abnormal drop in systolic blood pressure during inspiration, commonly seen in cardiac and respiratory conditions. Clinicians should measure blood pressure during both inspiration and expiration, noting a difference exceeding 10 mm Hg as indicative of pulsus paradoxus.
Peirtonsillar abscess
Complication of bacterial tonsillitis
Atopic
Genetic tendency to develop allergic diseases such as allergic rhinitis, asthma and atopic dermatitis (eczema)
Asthma
Heterogenous disease usually characterised by chronic airway inflammation
Symptoms: wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity together with variable expiratory airflow limitation
Clinical definition of asthma
Recurrent episodes of wheezing (> or equal to 3 after 1 year if age) with or without a cough, that response to a bronchodilator)
Other important features for history of asthma
History of other allergic disease
Allergic rhinitis
Eczema
Allergic conjunctivitis
Preterm baby, ventilation
Family history of Allergies or asthma
Social history: home and school environment, day care, cultural beliefs
Appearance of asthmatic people
Shiners - under eyes
Mouth breathers
The allergic salute- hand pushing up nostrils
Anaphylaxis
Several life threatening allergic reaction- gaolers seconds or minutes after you’ve been exposed to something you’re allergic to
Type 1 - IgE
Angioedema
Swelling that is similar to hives but is under the skin, not on the surface like hives
Urticaria
Also called hives
Swollen itchy welts
Chronic welts last more than 6 weeks and return over months or years
True or false: every child with a wheeze is asymptotic
False
Wheezing…
Caused by turbulent airflow through narrow airways causing vibration of the airways
This narrowing can either be because if mucus in the lumen of the airway or because if muscle spasm of the airways/bronchospasm
Other causes of recurrent wheezing in preschool children besides viral
Laryngomalacia
Vocal cord paresis
Vascular rings and slings
TB - cause of TB lymph nose causing obstruction
GORD - most common aspiration syndrome but others include tracheo- oesophageal fistula, laryngeal clefs and swallowing in- coordination
Cardiac failure is a very common cause of wheezing
Laryngomalacia
Laryngomalacia is a congenital softening of the tissues of the larynx (voice box) above the vocal cords. This is the most common cause of noisy breathing in infancy. The laryngeal structure is malformed and floppy, causing the tissues to fall over the airway opening and partially block it.
Vocal cord paresis
Recurrent laryngeal nerve paralysis
Affects mobility of the vocal cords
Usually by injury
True or false: asthma is the least likely of wheezing in preschoolers
True
Asthma has reversibility of airway obstruction - at what age can we check this using peak expiratory flow rate or spirometer
Usually possible after age 5 in a well cooperative child
True or false: atopic diseases are poorly diagnosed
Yes
Most pts do not complain
Harrison’s sulcus
Indentation on the chest roughly along the 6th rib usually bilateral
Presenting Signs of neurological encephalopathy
Abnormal LOC
Depressed tone/refelexes
Seizures
Difficulty initiating / maintaining respiration
HIE
Hypoxia ischaemic encephalopathy
Neonatal encephalopathy in the first few days following a perinatal hypoxic ischaemic event
What do survivors of HIE have in terms of neurological abnormalities
Cerebral palsy
Causing spastic quadriplegic/dykinetic
Cerebral palsy
Group of disorder that affect the peronson’s ability to move, balance and maintain posture
Caused by abnormal brain development or damage to brain that occurs before or after birth
Most common motor disposability in children affecting 3/1000 live births
Neonate
A newborn baby up until 28 weeks
Risk groups for HIE
Maternal diabetes
IUGR
Post mature Breech
Perinatal events
Maternal, placenta, uterine, cord and intraprtum infection
Watershed zones
Watershed locations are those border-zone regions in the brain supplied by the major cerebral arteries where blood supply is decreased. Watershed strokes are a concern because they comprise approximately 10% of all ischemic stroke cases.
Perinatal leucomalacia
Form of white matter brain injury characterised by necrosis of white matter near the lateral ventricles
Can affect newborns and fetuses, premature infants are at the greatest risk of neonatal encephalopathy
Erventricular leu
