Low-molecular-weight heparin use in a case of noncardiogenic multifocal perinatal thromboembolic stroke

Abstract

A full-term neonate suffered multifocal cerebral infarctions due to multiple large vessel thrombi. Thrombophilia and cardiovascular assessments were negative, but due to the severity of the lesions and the concern for expansion of the thrombi or future embolic events, treatment with low-molecular-weight heparin (LMWH) was initiated. No complications from treatment were experienced. We present this severe case in order to highlight difficult management decisions for newborns with multifocal perinatal thromboembolic stroke and to stress the need for further practice guidelines and research in this area.

Figure 1

(a)–(c): Axial diffusion-weighted images, b = 1000, demonstrate multiple areas of high signal in bilateral frontal and parietal lobes, left occipital lobe, left thalamus, and left pons.

Figure 2

3D maximum-intensity projection (MIP) image from a 3D time of flight MRA demonstrates occlusion of the right internal carotid artery at its origin (arrow). The vertebral arteries are diminutive (arrowheads) and the basilar artery is not visualized.

Figure 3

3D MIP images from a noncontrast 2D time of flight MRA demonstrate restoration of flow in the right internal carotid artery and posterior circulation. Residual occlusion of the distal right PCA persists (arrow).