Ischemic and Hemorrhagic Perinatal Stroke in a Neonatal Intensive Care Unit: A 10-Years Survey

Background: Perinatal stroke has been associated with a multifactorial etiology and it is an important cause of long term neurologic impairment.

Methods: This is a retrospective study on risk factors, clinical manifestations and follow-up of newborns admitted in a level three Neonatal Intensive Care Unit between January 2006 and December 2015 with the final diagnosis of perinatal stroke. The selected perinatal stroke cases were those with magnetic resonance imaging confirmation and the selected risk factors were chosen based on recent review studies or meta-analyzes.

Results: Seventeen cases were identified (13 ischemic and four hemorrhagic) and the most common clinical presentation was seizure, 20 to 48 hours after delivery, occurring in 88% of newborns. All ischemic stroke cases had at least one specific risk factor, and 60% had more than three. Only one hemorrhagic stroke case had a specific risk factor. Four placentas had histological abnormalities. A prothrombin gene mutation was detected in one ischemic stroke case. There was no stroke recurrence or death, with a mean follow-up of 43 months. 62% of the infants had neurologic sequelae (motor impairment and epilepsy). All ischemic stroke cases with more than two risk factors had neurologic sequelae.

Conclusions: Ischemic stroke cases usually presented specific risk factors. An association between risk factors´ number and a worse neurologic outcome was also observed in ischemic stroke cases.

Keywords: Perinatal stroke, neonatal seizures, newborn, risk factors.