Seizures and cerebral infarction in the full‐term newborn

Abstract

Cerebral arterial infarction is a more common cause of neonatal seizures than has been previously appreciated. In 50 full-term newborns with seizures studied, 7 had cerebral infarction which was the second most common definable cause of seizures. We describe these 7 full-term infants with cerebrovascular accidents who presented with focal or generalized seizures. Obstetrical histories were normal in 5 of these patients. Their neurological examinations demonstrated lethargy and generalized hypotonia. Electroencephalograms demonstrated focal abnormalities in 4 infants. Computed tomographic scans in the first week of life showed infarctions in 6 newborns and in another at age 6 months. Neonatal stroke should be considered as a cause of seizures in a full-term newborn in spite of a normal obstetrical history and a nonfocal neurological examination.

Cerebrovascular disease in neonates: evaluation of four cases

“…Some authors 2,3,5 stated that the presence of polycythemia, disseminated intravascular coagulation, infections and hypercoagulopathy, appear to be rather non specific, but may be correlated to acute CVD. Sometimes, the cause that produces cerebral infarction in neonatal period is unclear, and some condictions should be considered as increased incidence of heterozygocity for factor V Leyden, lactate level, antiphospholipid antibodies, homocysteinuria 4,8,9 .…”

“…The early diagnosis of cerebral infarction in children, is possible by utilization of cranial ultrasound (US), computed tomography (CT) and magnetic resonance (MRI). The doppler-ultrasonography examination is a sensitive method for evaluation of regional blood flow changes, and with CT it has been possible establish diagnosis and localization of a strutural lesion [1][2][3][4][5][6] .…”

Evolution of Unilateral Perinatal Arterial Ischemic Stroke on Conventional and Diffusion-Weighted MR Imaging

“…1,8 These seizures may be, but are not always, contralateral to the site of infarction, are mostly clonic in nature, and can be subtle 9 ; sometimes the presenting symptoms are apnea, duskiness, poor feeding, hypotonia, and irritability. 10,11 PAIS is occasionally associated with hypoxic-ischemic encephalopathy (HIE). 12,13 The timing of presentation is often Ͼ2 hours after birth and may be up to 3-4 days.…”

Perinatal stroke – risk factors and management

“…Similarly, in the Canadian Stroke registry, seizures were present in 85% of cases and hemiparesis in only 7% (de Veber et al, 1998). The importance of seizures as a presenting feature is further emphasised in studies looking specifically at seizures in the newborn period where it has been estimated that around 12-14% may be the result of underlying stroke (Levy et al, 1985;Estan & Hope, 1997). In most cases seizures and other non-specific features are noted during the first 24-72 h following delivery.…”

“…Pregnancy-related factors are not recorded in all studies of perinatal stroke but, where they are, the incidence of antenatal complications ranges from 0 to 64% (Levy et al, 1985;Koelfen et al, 1995;Fujimoto el al, 1992;Golomb et al, 2001). Specific complications in these studies again include pre-eclampsia and IUGR, as well as maternal diabetes, maternal infection and antenatal trauma.…”