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Perinatal Stroke in Fetuses, Preterm and Term Infants
R Srivastava1, J Mailo1, M Dunbar2
1Division of Pediatric Neurology, Department of Pediatrics, University of Albertam, AB, Canada.
Insights
Perinatal stroke, a disruption of brain blood flow in newborns, is a leading cause of lifelong cerebral palsy. This review details risk factors, diagnosis, and management for fetal, preterm, and term neonatal stroke.
Area of Science:
- Neurology
- Pediatrics
- Neonatology
Background:
- Perinatal stroke involves focal cerebral blood flow disruption from 20 weeks gestation to 28 days postnatal.
- It is the primary cause of hemiparetic cerebral palsy, leading to lifelong disability.
- The first week after birth presents the highest risk for perinatal stroke.
Approach:
- This review classifies perinatal strokes by timing (fetal, preterm neonatal, term neonatal, infancy/childhood).
- It details risk factors, diagnostic methods, and treatment strategies.
- The review also covers outcomes, controversies, and family support resources.
Key Points:
- Perinatal stroke affects both term and preterm infants, with distinct vulnerabilities in the preterm brain.
- Classification by age at presentation is crucial for accurate diagnosis and management.
- Understanding perinatal stroke syndromes impacts prognosis and long-term care.
Conclusions:
- Accurate diagnosis and classification of perinatal stroke are essential for effective intervention.
- This review provides a comprehensive summary of current knowledge on perinatal stroke.
- Early identification and management can mitigate the lifelong impact of cerebral palsy.
Abstract:
Perinatal stroke is a well-defined heterogenous group of disorders involving a focal disruption of cerebral blood flow between 20 weeks gestation and 28 days of postnatal life. The most focused lifetime risk for stroke occurs during the first week after birth. The morbidity of perinatal stroke is high, as it is the most common cause of hemiparetic cerebral palsy which results in lifelong disability that becomes more apparent throughout childhood. Perinatal strokes can be classified by the timing of diagnosis (acute or retrospective), vessel involved (arterial or venous), and underlying cause (hemorrhagic or ischemic). Perinatal stroke has primarily been reported as a disorder of term infants; however, the preterm brain possesses different vulnerabilities that predispose an infant to stroke injury both in utero and after birth. Accurate diagnosis of perinatal stroke syndromes has important implications for investigations, management, and prognosis. The classification of perinatal stroke by age at presentation (fetal, preterm neonatal, term neonatal, and infancy/childhood) is summarized in this review, and includes detailed descriptions of risk factors, diagnosis, treatment, outcomes, controversies, and resources for family support.
