Sonographic and Doppler Sonographic Diagnosis of Neonatal Ischemic Stroke

Children are particularly at risk for stroke in the neonatal period. 1/3 of all strokes in children occur during the perinatal period. The incidence of perinatal stroke is 1:4000. A differentiation is made between ischemic stroke and hemorrhagic stroke. Ischemic strokes are caused by arterial occlusion due to thrombosis or embolism. As a result of the nonspecific clinical symptoms in this age group, diagnosis is usually made too late. The only relatively specific symptom is focal cerebral seizure during the first week of life. Therefore, stroke should be ruled out by diagnostic imaging in the case of any seizure in the first days of life. Although the diagnostic method of choice is MRI, it is not always available. Most neonatal ischemic strokes can be detected with high-resolution duplex ultrasound. On ultrasound, ischemic stroke appears as a wedge-shaped focal increase in echogenicity in the supply region of an artery, typically the middle cerebral artery. The corresponding arterial inflow can be visualized with duplex ultrasound and measured with spectral Doppler. Doppler ultrasound can be used to differentiate between complete occlusion and severe stenosis. The success of therapeutic measures can be determined in the further course with Doppler ultrasound on the basis of the recanalization of vessels and the morphological consequences of stroke (cyst formation due to liquefactive necrosis).