Learning objectives
To acknowledge the importance of perinatal/neonatal stroke and acquire basic knowledge of its clinical presentation and pathophysiology.
To discuss imaging modalities used in perinatal/neonatal stroke evaluation.
To review the fundamental radiological findings through our institution case series.
Background
Perinatal stroke is an underestimated entity even though it corresponds to 25% of pediatric stroke patients [1]. It encompasses from 20 gestational weeks up to 28 days of life, most of them being neonatal arterial ischemic strokes (NAIS). Other subtypes comprise hemorrhagic stroke, cerebral sinovenous thrombosis (CSVT), and periventricular venous infarction (PVI), which will not be reviewed here [2, 3]. NAIS has an incidence of 35 per 100,000 live births 2300-5000 births [2-4], shows a male predilection and the left middle cerebral artery (MCA) is...
Findings and procedure details
We found 13 patients, 9 females (60%) and 4 males (40%). In all cases the middle cerebral artery territory was involved, 77% in the left hemisphere. 3 cases showed bilateral involvement.
As aforementioned, imaging plays a fundamental role in the evaluation of NAIS patients, so Radiologists must be familiar with imaging protocols and NAIS radiological findings (figures 1 & 2). [Fig 1][Fig 2]
A. US
Ultrasound is the first-line imaging modality because of its lack of ionizing radiation, portability, availability, and economic factors [7, 8]....
Conclusion
Perinatal stroke is an underestimated entity and it typically manifests through seizures. Radiologists must be familiar with perinatal IAS and its radiological findings. Head Doppler US should be the first imaging modality in newborns. Doppler US increases US sensitivity. MRI offers a much complete evaluation of the patient contributing to clarify the diagnosis and prognosis in each case, so it is mandatory to evaluate newborns with suspected AIS. DWI is the most sensitive sequence and MRA and MRV are recommended in the evaluation. Pharmacological sedation...
Personal information and conflict of interest
R. Teruel Coll:
Nothing to disclose
V. Belloch Ripollés:
Nothing to disclose
N. Boronat González:
Nothing to disclose
R. Llorens-Salvador:
Nothing to disclose
A. Moreno-Flores:
Nothing to disclose
References
Barkovich AJ, Raybaud C, Schwartz ES, Barkovich AJ. Brain and Spine Injuries in Infancy and Childhood. In: Pediatric neuroimaging. 6th ed. Philadelphia, Pensilvania: Wolters Kluwer; 2019. p. 378–463.
Barkhof F, Jager R, Thurnher M, Cañellas Alex Rovira, Argyropoulou MI, Vasiliki C. 57. Neonatal Hypoxia-Ischemia. In: Clinical Neuroradiology: The ESNR Textbook. Cham, N/A: Springer International Publishing; 2019. p. 1585–608.
Ichord R. Stroke in the newborn: Classification, manifestations, and diagnosis. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on February 01, 2020)
Clive B, Vincer M,...