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Perinatal Arterial Ischemic Stroke: Presentation, Risk Factors, Evaluation, and Outcome

  • Laura L. Lehman
    Affiliations
    Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
    Search for articles by this author
  • Michael J. Rivkin
    Correspondence
    Communications should be addressed to: Dr. Rivkin; Department of Neurology; Boston Children's Hospital; Pavilion 154; 300 Longwood Avenue; Boston, Massachusetts 02115.
    Affiliations
    Department of Neurology, Boston Children's Hospital, Boston, Massachusetts

    Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts

    Department of and Radiology, Boston Children's Hospital, Boston, Massachusetts
    Search for articles by this author

      Abstract

      Background

      Perinatal arterial ischemic stroke is as common as large vessel arterial ischemic stroke in adults and leads to significant morbidity. Perinatal arterial ischemic stroke is the most common identifiable cause of cerebral palsy and can lead to cognitive and behavioral difficulties that are amortized over a lifetime.

      Methods

      The literature on perinatal arterial ischemic stroke was reviewed and analyzed.

      Results

      Risk factors for perinatal arterial ischemic stroke include those that are maternal, neonatal, and placental. The most common clinical signs at presentation are seizures and hemiparesis. Evaluation should begin with thorough history acquisition and physical examination followed by magnetic resonance imaging of the brain, with consideration of magnetic resonance angiography of the head and neck, echocardiogram, and thrombophilia evaluation. Treatment beginning early to include physical, speech, and occupational therapies including constraint-induced movement therapy and close cognitive and developmental follow-up may be beneficial. Future treatments may include transcranial magnetic stimulation, hypothermia, and erythropoietin.

      Conclusions

      Perinatal arterial ischemic stroke comprises a group of arterial ischemic injuries that can occur in the prenatal, perinatal, and postnatal periods in term and preterm infants with different types of perinatal arterial ischemic stroke having different clinical presentations, risk factors, and long-term outcomes.

      Keywords

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