Article Text

IS-029 Neonatal Stroke
  1. L de Vries,
  2. NE van der Aa,
  3. F Groenendaal,
  4. MJNL Benders
  1. Neonatology, Wilhelmina Children’s Hospital University Medical Center Utrecht, Utrecht, Netherlands

Abstract

Neonatal stroke may be defined as cerebrovascular injury, which occurs around birth. Neonatal stroke is most often referred to as perinatal cerebral injury of ischaemic origin. Two common subtypes are perinatal arterial ischaemic stroke (PAIS, 70%) and cerebral sinovenous thrombosis (CSVT, 30%).

PAIS has an incidence between 1/1600 and 1/5000. PAIS may affect both full-term and preterm born infants. Several studies have reported a male predominance of approximately 60%, and PAIS is known to more often involve the left hemisphere. Seizures are the most common first clinical sign of PAIS, occurring in 70–90% of all infants with PAIS and are often focal (hemiconvulsions).

The diagnosis is made with neuro-imaging techniques. MRI is the most sensitive imaging modality for detection of PAIS. Diffusion weighted imaging (DWI) plays the most important role in the diagnosis of PAIS due to its high sensitivity for detecting ischaemic lesions in the acute phase.

MRI and especially DWI (restricted diffusion on DWI at the level of the corticospinal tracts) play an important role in the prediction of motor outcome, especially for development of unilateral spastic cerebral palsy (USCP).

During the acute phase, therapeutic options are limited and mainly involve supportive. Beyond the neonatal period, therapy is aimed at treatment of sequelae. Constraint induced movement therapy (CIMT), which addresses the non-use of the affected hand has shown positive results in children with USCP and can already be applied at a young age.

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