Perinatal Stroke: Clinical Pearls and Future Directions

Abstract

Perinatal strokes are disorders of cerebral vasculature occurring in the developing brain between 20 weeks of gestation and 28 days postnatally (Raju, 2007). This review describes specific types of perinatal strokes and includes up-to-date risk factors, clinical presentations, outcomes, and management including expert consensus and controversies. We will conclude with a discussion of new research focused on optimizing the quality of life for children with stroke and their families. Perinatal stroke can present acutely and should be considered for any newborn with unexplained encephalopathy or seizures, particularly those that are focal in nature. Presumed perinatal stroke syndromes present later in infancy with motor and sensory asymmetry. In either case, neuroimaging helps identify a specific perinatal stroke syndrome. Most perinatal stroke survivors experience long-term morbidity, inclusive of cerebral palsy (CP), epilepsy, cognitive and behavioural disabilities, and visual deficits. Significant progress has been made in understanding cerebrovascular injuries of the developing brain and the role of early rehabilitation in recovery. With limited preventative and acute treatment options available, long-term neurorehabilitation continues to be the focus of treatment. Equally important is to recognize the significant psychosocial impact of perinatal stroke on the entire family. Online resources and support systems are increasingly available through national and international pediatric stroke organizations.