Neonatal arterial ischemic stroke: an imaging overview

Perinatal stroke (PS) is a heterogeneous group of cerebrovascular diseases occurring between 20 weeks of gestation and 28 days of post-natal life. PS may be due to arterial or venous compromise resulting in an ischemic or hemorrhagic injury to the brain. Arterial ischemic stroke (AIS) is the most common form of PS, with neonates (between 0-28 days) being at a particularly increased risk. Several risk factors have been implicated in the development of neonatal AIS (NAIS), including but not limited to complicated labor, infection, poor Apgar score, and metabolic derangements. Seizures are the most common presentation of NAIS. MRI is the investigation of choice in cases of suspected NAIS, enabling identification of the injury, detection of vascular changes, and associated downstream network injury. Even though treatment is primarily supportive, various MRI techniques have played a key role in understanding functional and microstructural changes following NAIS as well as predicting outcomes, thereby empowering clinicians and parents to make informed decisions about future care and rehabilitation.