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Stroke in the newborn: Management and prognosis

Author
Rebecca Ichord, MD
Section Editors
Douglas R Nordli, Jr, MD
Joseph A Garcia-Prats, MD
Deputy Editor
John F Dashe, MD, PhD

INTRODUCTION

Perinatal stroke may be defined as an acute neurologic syndrome with chronic sequelae due to cerebral injury of vascular origin occurring between 20 weeks gestation and 28 days postnatal life. These disorders include focal cerebral injury due to arterial ischemic stroke, cerebral venous thrombosis, and primary intracerebral hemorrhage. Perinatal stroke is a common cause of acute neonatal encephalopathy, and may manifest as seizures, altered mental status, and sensorimotor deficits. It is an important cause of chronic neurologic disability.

The management and prognosis of perinatal stroke are reviewed here. Other clinical aspects are discussed separately. (See "Stroke in the newborn: Classification, manifestations, and diagnosis".)

MANAGEMENT

Management of perinatal stroke is supportive. It should be directed at treatment of underlying conditions and prevention of further injury. Thus, it is important to ensure adequate oxygenation and ventilation, to correct dehydration and anemia, and to monitor and correct metabolic disturbances, including acidosis, hypoglycemia, hypocalcemia, and electrolyte disorders [1]. If infection is suspected, antibiotic treatment should be started until culture results are available.

Seizures should be treated with anticonvulsant medications. Because clinical identification of seizures is unreliable in neonates, prolonged video-electroencephalogram monitoring may be necessary to accurately characterize the extent, nature, and localization of clinical versus electrographic seizures. (See "Clinical features, evaluation, and diagnosis of neonatal seizures".)

Programs incorporating physical, occupational, and speech therapy may help to improve functional outcomes for children with perinatal stroke [2].

             
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Literature review current through: Oct 2017. | This topic last updated: Sep 28, 2017.
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