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Published on: November 20, 2015
Perinatal stroke--risk factors and management
1Department of Haematology, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK. elizabeth.chalmers@yorkhill.scot.nhs.uk
Insights
Pediatric stroke, often thromboembolic, is a serious cause of childhood mortality and neurological issues, particularly in newborns. Understanding its complex, multifactorial causes requires interdisciplinary collaboration for better prevention and treatment.
Area of Science:
- Pediatric Neurology
- Neonatology
- Hematology
Background:
- Stroke is an uncommon but significant cause of mortality and long-term neurological morbidity in children.
- Cerebral thromboembolic events are a major contributor, with incidence peaking in the neonatal period.
- Perinatal strokes may have distinct risk factors compared to those in older children, potentially occurring in utero or perinatally.
Purpose of the Study:
- To explore the complex pathophysiology of perinatal stroke.
- To identify multifactorial risk factors, including maternal, placental, fetal, and neonatal disorders.
- To highlight the need for interdisciplinary collaboration and investigate the role of prothrombotic abnormalities and antithrombotic agents.
Main Methods:
- Review of existing literature on childhood stroke and thromboembolic disease.
- Analysis of potential risk factors in maternal, placental, fetal, and neonatal populations.
- Discussion of the implications for hematology, focusing on prothrombotic states and antithrombotic therapies.
Main Results:
- Perinatal stroke pathophysiology is complex and often multifactorial.
- Risk factors encompass maternal, placental, fetal, and neonatal conditions.
- Prospective studies are needed to delineate the contribution of each factor.
Conclusions:
- Perinatal stroke is a complex condition requiring a multidisciplinary approach involving obstetrics, fetal medicine, pathology, neonatology, and neurology.
- Further research is essential to understand the contribution of prothrombotic abnormalities and evaluate antithrombotic strategies for management and prevention.
Abstract:
Stroke is an uncommon but increasingly recognised cause of mortality and long-term neurological morbidity in children. A significant number of these events appear to be caused by thromboembolic disease and, as with other childhood thrombotic problems, the incidence of central nervous system events appears highest during the neonatal period. In contrast to peripheral arterial and venous thrombotic problems, it is likely that a proportion of cerebral thromboembolic events occur either in utero or perinatally and reflect different risk factors from those occurring in older infants and children. The pathophysiology of perinatal stroke is complex and in many cases is likely to be multifactorial. It is now recognised that risk factors may relate to both maternal and placental problems as well as fetal and neonatal disorders. Large prospective studies of perinatal stroke are currently lacking and efforts to define the relative contribution from each of these areas are at an early stage. The complex nature of these disorders requires collaboration between a number of different disciplines including obstetrics, fetal medicine, pathology, neonatology and neurology. Of particular interest to haematologists is the possible impact of prothrombotic abnormalities in the pathophysiology of these events and also the potential for the use of antithrombotic agents in both management and prevention.
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