Focal motor seizures heralding stroke in full-term neonates

We describe the clinical syndrome, medical management, etiology, and neurologic outcome of stroke diagnosed by computed tomographic scan in 11 full-term neonates encountered during a two-year period. Neonatal stroke is relatively common and may appear in the setting of diverse cerebrovascular disorders such as hypoxic-ischemic encephalopathy, polycythemia, acute severe hypertension, and embolization. Repetitive, persistently unifocal motor seizures heralded localized cerebral injuries in eight infants. The majority of patients did not display any other lateralized clinical neurologic signs. An electroencephalogram revealed a focal or lateralized functional central nervous system abnormality in ten cases. All of the initial computed tomographic scans were focally abnormal. However, cranial ultrasound examinations were insensitive to stroke in nine patients. Medical management included careful cardiorespiratory support, correction of coexisting metabolic or system abnormalities, and aggressive administration of anticonvulsants to promptly eliminate seizures. Limited follow-up suggests that many affected infants may enjoy favorable outcomes.