Clinical presentations and neurodevelopmental outcomes of perinatal stroke in preterm and term neonates: a case series

Abstract

Perinatal stroke in neonates can lead to disability in later life. However, its etiology and prognosis are poorly understood. The aim of this study was to describe clinical presentations and neurodevelopmental outcomes of our case series of perinatal stroke in Korea. Thirteen term and preterm neonates who were diagnosed with perinatal stroke in two university hospitals from March 2003 to March 2007 were enrolled. Seven term and 6 preterm neonates were diagnosed with perinatal stroke, based on the brain MRI findings. Perinatal stroke presented with seizure (4/13), perinatal distress (3/13) in term neonates, whereas stroke in preterm neonates did not present with noticeable clinical symptoms. Only one neonate had positive thrombophilic test (homozygous C677T polymorphism for MTHFR). Ten neonates had infarctions in the territory of the middle cerebral artery (MCA), and 3 neonates had borderzone infarctions between the anterior cerebral artery and MCA. Neurodevelopmental outcome was abnormal in 4 neonates. Infarction in MCA main branch or posterior limb of internal capsule showed an abnormal neurodevelopmental outcome. Our study is the first systematic study of perinatal stroke in Korea, and shows its clinical presentations and neurodevelopmental outcomes. The population-based study on incidence and prognosis of perinatal stroke in Korea is required in the future.

Keywords: Magnetic Resonance Imaging; Newborn; Perinatal Stroke.

Fig. 1

Brain MRI findings of patient 9. (A) Axial diffusion-weighted image showing hyperintensity in the territory of left middle cerebral artery. (B) MR angiography demonstrates loss of flow distal to the left middle cerebral artery bifurcation.

Fig. 2

Brain MRI finding of patient 13. Axial diffusion-weighted image showing hyperintensity in right thalamus and posterior limb of internal capsule.