Neonatal Stroke Is Not a Harmless Condition

Abstract

See related article, pages 2012–2019. Neonatal arterial ischemic stroke, defined as a cerebrovascular event occurring between birth and 28 days postnatally with pathological or radiological evidence of focal arterial infarction, is now an increasingly recognized condition. The incidence is commonly referred to as 1/4000 live births,1–4 but higher rates were recently reported.5 Because focal neurological signs of stroke are usually not evident in newborns, there are reasons to believe that the reported incidence of neonatal stroke in a given geographic region is strongly related to the use of neuroradiological techniques. There is now an emerging consensus that all infants with confirmed neonatal seizures should ideally undergo diagnostic neuroimaging to detect ischemic lesions. MRI is clearly the most sensitive technique.6 The etiology of neonatal stroke is not fully elucidated. In only half to three-quarters of cases3,7 can a cause be identified. Major risk factors include prothrombotic disease, congenitial heart disease, and perinatal risk factors such as prolonged rupture of membranes and chorioamnionitis.4,8,9 It is interesting to note that neonatal arterial ischemic stroke is related to abnormalities in the coagulation system rather than to fibrinogen activation, as commonly seen in adult stroke. Neonates seem to be at higher risk for stroke than older children,10 which may be because of …