Focal cerebral infarction in the newborn: a distinct entity

Recent reports, which described early computed tomography findings of unsuspected cerebral arterial infarctions in term newborns who presented with seizures, prompted a review of our neonatal intensive care unit records. Seven newborns demonstrated arterial infarctions by computed tomography. Five of the 7 had focal motor seizures and 2 had generalized seizures. Electroencephalograms of 6 infants correlated with the area of infarct, mainly disclosing focal spike- and/or sharp-wave activity. All infarcts involved the territory of the middle cerebral arteries and all were evident on initial scans. Subsequent examinations at age 12 months to 9 years demonstrated 4 children with spastic hemiparesis, and 3 children with normal neurologic examinations. Neonatal cerebral arterial infarction is a distinct entity which should be recognized and should be included in the differential diagnosis of neonatal seizures, regardless of the presenting symptoms or predisposing factors.