Duplex Sonographic Diagnosis of Perinatal Hemorrhagic Stroke

Children are particularly at risk for stroke in the neonatal period. Neonatal hemorrhagic stroke is rarer than ischemic stroke. The incidence is 40.7/100 000 live births. Hemorrhagic stroke is caused by a disruption in venous drainage usually due to local thrombosis. As a result of the nonspecific clinical symptoms in this age group, diagnosis is usually made too late. The only relatively specific symptom is a 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. The diagnostic method of choice is MRI, but it is not always available. Most neonatal strokes can be detected with high-resolution duplex ultrasound. Hemorrhagic stroke appears as a focal increase in echogenicity in a venous drainage area on ultrasound. The corresponding venous drainage can be visualized with duplex ultrasound and measured with spectral Doppler. Hemorrhagic stroke of the internal veins appears as hemorrhage in the basal ganglia. Venous thrombosis must be ruled out in every cerebral hemorrhage of unclear origin in an otherwise healthy term newborn. In the case of hemorrhagic infarction of the basal ganglia, both internal cerebral veins, the great vein of Galen, and the straight sinus must be examined with Doppler ultrasound. Doppler ultrasound should be used to differentiate between complete occlusion and severe stenosis. The recanalization of vessels and the morphological consequences of hemorrhagic stroke can be visualized in the further course.