Sir,

In a recent, elegant study Govaert et al published their ultrasonographical observations in newborn infants with perinatal cortical infarctions (1). Like many others before them, they could not find a cause for stroke in a high proportion in (25%) of cases. They also confirmed an association between stroke and pulmonary hypertension requiring assisted ventilation (2).

We have previously published observations on arteficially ventilated newborn piglets with pneumothorax and pulmonary hypertension, where we demonstrated cerebral arterial air microembolisations microscopically (3,4). In the case of arteficial ventilation, which is accompanied frequently by pulmonary air leak syndrome (pulmonary interstitial emphysema, pneumomediastinum, pneumothorax), air can reach easily the cerebral vasculature, especially when there is persistent pulmonary hypertension and right-to-left intracardial shunts.

In the light of our observations, as air microemboli could not be detected ultrasonographically, I have a suspicion that perinatal cortical infarction might have been due to cerebral arterial air embolisation in some patient in the study by Govaert et al.

References

1. Govaert P, Matthys E, Zecic A, Roelens F, Oostra A, Vanzieleghem B. Perinatal cortical infarction within middle cerebral artery trunks. Arch Dis Child 2000;82:F59-F63.

2. Klesh KW, Murphy TF, Scher MS, Buchanan DE, Maxwell EP, Guthrie RD. Cerebral infarction in persistent pulmonary hypertension of the newborn. Am J Dis Child 1987;141:852-7.

3. Temesvári P, Kovács J, Rácz K. Cerebral arterial air embolisation in experimental neonatal pneumothorax. Arch Dis Child 1989;64:179.

4. Temesvári P, Kovács J, Ábrahám CS. Pneumothorax and neonatal stroke. Neuropediatrics 1996;27:167-8.

Péter Temesvári
University Teaching Hospital
Department of Pediatrics
Kecskemét, Hungary

Address: H-6001, P.O.Box : 149
Kecskemét, Hungary
Phone: 36-76-484-384
FAX: 36-76-484-040
E-MAIL: temespete@hotmail.com