Neonatal stroke

Abstract

The perinatal ischemic stroke is defined as "a group of heterogenous conditions with a focal disruption of cerebral flow secondary to an arterial or a venous thrombosis or embolization between the 20 week of foetal life through the 28 post-natal day". Three subgroups are identified: arterial ischemic stroke (AIS), cerebral sinovenous thrombosis (CSVT) and haemorragic infarct. Many strokes are detected in the neonatal period due to early onset seizures, although symptoms can be more subtle leading to a significant delay in the diagnosis. MRI-DWI remains the best tool for a correct diagnosis, extension of the lesion and suggestion of timing. Lesions detected in utero or at early neonatal imaging with signs of tissue loss are considered "foetal stroke". The "neonatal stroke", with the symptoms in the first 4 days, shows the typical abnormalities of the acute phase evolving later in a white matter loss. The AIS shows the ischemic area of restriction at the early DWI in a arterial territory, mainly the middle cerebral artery. The MR-Venogram is useful in the CVST to detect the thrombus in a sinovenous vessel and the potentially associated lesion, such as intraventricular haemorrage and parenchymal oedema. The extension of the lesion and the involvement of the basal ganglia and thalami have a negative prognostic value for the development of hemiplegia especially in the presence of abnormal PLIC. An early diagnosis.