Perinatal stroke

• What is Perinatal stroke
• Statistics on Perinatal stroke
• Risk Factors for Perinatal stroke
• Progression of Perinatal stroke
• Symptoms of Perinatal stroke
• Clinical Examination of Perinatal stroke
• Prognosis of Perinatal stroke
• How is Perinatal stroke Treated?
• Perinatal stroke References

What is Perinatal stroke

Perinatal (around birth) stroke is defined as a stroke occuring around the time of birth. It is an increasingly recognised cause of neurological disabilities such as cerebral palsy, epilepsy, and cognitive abnormalities ³.
A stroke is sudden decrease or loss of consciousness, sensation, and voluntary motion caused by rupture or obstruction (as by a clot) of a blood vessel of the brain. It is a common condition in adults, and is becoming increasingly known in newborns and children.

Statistics on Perinatal stroke

The rate of occurrence of new cases of perinatal stroke is about 93 in 100,000 live births.
A recent study in the U.S. reported the percentage of the population affected with perinatal stroke at a given time to be 20 in 100,000 live births.
Most babies affected are born singly (not multiple pregnancies e.g. twins or triplets) and are delivered at term.

Risk Factors for Perinatal stroke

In a large number of cases, no cause could be found.
However, a number of risk factors related to the mother and fetus have been identified:
1) Antenatal/pregnancy-related:
 

• Maternal hypertension, growth restriction in the uterus, maternal diabetes.

 
2) Perinatal (around birth):
 

• Caesarean section, assisted delivery e.g. forceps etc, birth asphyxia (lack of oxygen or excess of carbon dioxide), birth trauma/injury

 
3) After birth:
 

• Heart disorders, pulmonary hypertension (high blood pressure in the lungs), infection, blood disorders with a tendency to clotting

 

Progression of Perinatal stroke

There are two types of perinatal stroke: acute presentation and delayed presentation.
In acute presentation of perinatal stroke, the neurological symptoms occur before 28 days of life; whereas in delayed presentation, children remain neurologically normal until the age of 4 to 8 months when they have a hemiparesis (muscle weakness or partial loss of function on one side of the body)

Prognosis of Perinatal stroke

The likely outcomes in the neurological system are:
 

• Cerebral palsy (more likely in delayed presentation)
• Fits after 1 month of life
• Language delay
• Behaviour abnormalities
• Children who present later tend to have a worse outcome, possibly due to the extent of injury when they go to the doctor. According to a recent study, delayed presentation was a predictor of the development of cerebral palsy eventually.In general, patients with a large stroke size and involvement of certain structures (e.g. precentral gyrus, Wernicke’s area, Broca’s area, basal ganglia and internal capsule as mentioned above) have a poorer prognosis.The risk of the disease coming back after an episode is relatively low.
  

  How is Perinatal stroke Treated?

  Treatment largely aims at preventing further clotting. This is done by giving unfractionated heparin or low melecular weight heparin. Delayed diagnosis limits treatment options in the early phase in a proportion of children.
  The role of preventive anti-clotting therapy during pregnancy is under research.
  

  Perinatal stroke References

  [1] Chalmers EA. Perinatal stroke – risk factors and management. Br J Haematol 2005;130(3):333-43.
  [2] de Veber GA, MacGregor D, Curtis R, Mayank S. Neurologic outcome in survivors of childhood arterial stroke and sinovenous thrombosis. J Child Neurol 2000; 15: 316-24.
  [3] Lee J, Croen LA, Lindan C, Nash KB, Yoshida CK, Ferriero DM et al. Predictors of outcome in perinatal arterial stroke: A population-based study. Ann Neurol 2005; 58(2): 303-8.
  [4] Monagle P, Chan A, Chalmers E, Michelson AD. Antithrombotic therapy in children: The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004; 126: 645S-687S.
  [5] Venkataraman A, Kingsley PB, Kalina P, Pavlakis SG, Buckwald S, Spinazzola R et al. Newborn brain infarction: clinical aspects and magnetic resonance imaging. CNS Spectrums 2004; 9: 436-44.