Perinatal stroke syndromes: Similarities and diversities in aetiology, outcome and management

Abstract

With a birth-prevalence of 37-67/100,000 (mostly term-born), perinatal stroke encompasses distinct disease-states with diverse causality, mechanism, time of onset, mode of presentation and outcome.Neonatal primary haemorrhagic stroke and ischemic events (also divided into neonatal arterial ischemic stroke and neonatal cerebral sinus venous thrombosis) that manifest soon after birth are distinguished from presumed perinatal -ischemic or haemorrhagic -stroke.Signs of the latter become apparent only beyond the neonatal period, most often with motor asymmetry or milestones delay, and occasionally with seizures. Acute or remote MRI defines the type of stroke and is useful for prognosis.Acute care relies on homeostatic maintenance. Seizures are often self-limited and anticonvulsant agents might be discontinued before discharge. Prolonged anticoagulation for a few weeks is an option in some cases of sinovenous thrombosis. Although the risk of severe impairment is low, many children develop mild to moderate multimodal developmental issues that require a multidisciplinary approach.

Clinical diversity of cerebral sinovenous thrombosis and arterial ischemic stroke in the neonate: a surveillance study.

“…Our ndings regarding onset of symptoms are in accordance with the literature with clinical presentation of AIS within the rst 12-72 h after birth in 70-90% [3] but there is scarce data on the onset of symptoms in CSVT. However, some evidence supports our nding that newborns with CSVT often present later with unspeci c signs within the rst week of life [24]. In a recent paper we discussed risk factors for AIS and identi ed an important role for prenatal risk factors [25].…”

Perinatal inflammation and placental programming of neonatal stroke

“…However, in rare diseases, even multisite epidemiological studies take a long time to be completed. With a birth prevalence of 6 to 17 per 100 000, neonatal arterial ischemic stroke (NAIS) is no exception . Two main mechanisms of NAIS are suspected, but rarely demonstrated in clinical practice: a thrombus embolizing from the placenta and, less commonly, a craniocervical arterial injury occurring during the birthing process .…”

Benefits of hypothermia in neonatal arterial ischemic strokes: A preclinical study

“…Due to the efficient anastomosis of the circle of Willis in pups, our experimental design requires adding hypoxic stress to the ischemia‐induced by RCCA ligation to trigger a stroke. However, the triple‐hit (namely, bacterial (LPS) component exposure plus focal ischemia plus global hypoxia) used in our experimental design is relevant with the most prevalent causal pathway of human NAIS featured by the sequence of chorioamnionitis (Giraud et al, 2017; Martinez‐Biarge et al, 2013; Sorg et al, 2019), peripartum asphyxia identified in up to 26% of NAIS (Fluss et al, 2019; Martinez‐Biarge et al, 2013; Michoulas et al, 2011; Ramaswamy, Miller, Barkovich, Partridge, & Ferriero, 2004; Sorg et al, 2019), and arterial occlusion of the carotid tree (Fluss et al, 2016; Husson et al, 2016; Kirton et al, 2011; Suppiej et al, 2019).…”

“…Neonatal arterial ischemic strokes (NAIS) affects up to 1–2/6,000 newborns and results in lifelong sequelae, such as cerebral palsy and epilepsy, as well as cognitive and behavioral impairments (Dunbar & Kirton, 2018; Fluss, Dinomais, & Chabrier, 2019; Giraud, Guiraut, Chevin, Chabrier, & Sébire, 2017). Clinical studies show that perinatal infection/inflammation—often due to chorioamnionitis—is the main independent risk factor of NAIS (Giraud et al, 2017; Martinez‐Biarge, Diez‐Sebastian, Wusthoff, Mercuri, & Cowan, 2013; Sorg et al, 2019).…”