Perinatal stroke is a focal vascular brain injury that occurs from the fetal period to 28 days of postnatal age. With an overall incidence of up to 1 in 1,000 live births, the most focused lifetime risk for stroke occurs near birth. Perinatal stroke can be classified by the timing of diagnosis, vessel involvement, and type of injury. Timing of diagnosis may be in the acute neonatal period or retrospectively after a period of normal development, followed by abnormal neurologic findings, with the injury presumed to have occurred around the time of birth. Strokes may be arterial or venous, ischemic, and/or hemorrhagic. Within these classifications, 6 perinatal stroke diseases are recognizable, based on clinical and radiographic features. Morbidity is high in perinatal stroke, because it accounts for most cases of hemiparetic cerebral palsy, with disability lasting a lifetime. Additional complications include disorders of sensation and vision, language delays, cognitive and learning deficits, epilepsy, and mental health consequences that affect the entire family. Advances in neonatal neurocritical care may afford opportunity to minimize brain injury and improve outcomes. In the chronic timeframe, progress made in neuroimaging and brain mapping is revealing the developmental plasticity that occurs, informing new avenues for neurorehabilitation. This review will summarize the diagnosis and management of each perinatal stroke disease, highlighting their similarities and distinctions and emphasizing a patient- and family-centered approach to management.
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March 2021
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March 01 2021
Perinatal Stroke: A Practical Approach to Diagnosis and Management
Ratika Srivastava, MD, FRCPC;
Ratika Srivastava, MD, FRCPC
*Department of Community Health Sciences;
†Department of Pediatrics, Section of Neurology; and
§Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada
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Adam Kirton, MD, MSc, FRCPC
Adam Kirton, MD, MSc, FRCPC
†Department of Pediatrics, Section of Neurology; and
‡Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
§Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada
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AUTHOR DISCLOSURE
Drs Srivastava and Kirton have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Neoreviews (2021) 22 (3): e163–e176.
Citation
Ratika Srivastava, Adam Kirton; Perinatal Stroke: A Practical Approach to Diagnosis and Management. Neoreviews March 2021; 22 (3): e163–e176. https://doi.org/10.1542/neo.22-3-e163
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