Neonatal Stroke: A Practical Approach to Neonatal Diseases

Thrombosis plays a role in many instances of neonatal ischemic stroke, be it arterial or venous. Apart from limb or visceral embolism and from intravascular manipulations, the clinical context is not specific of thrombotic stroke. To arrive at the diagnosis of primary thrombosis, a sequential diagnostic scheme has to be processed. First of all, entities that mimic stroke have to be appropriately excluded, which may not be straightforward in case of hypoglycemia or vascular malformation within the brain. Secondly, hemorrhagic stroke types, mainly lobar hematoma and subarachnoid hematoma, of cerebrum or cerebellum have to be recognized, sometimes because of a typical hemostatic context. Thirdly, apparent arterial or venous infarctions can be linked to obvious cranial birth trauma or to brain inflammation. Fourthly, vascular imaging of the cervical great vessels and of brain vessels may be needed to document congenital vascular malformations or arterio-/venopathy. Fifthly, a diligent search for primary thrombi outside the brain (in aorta or carotid arteries, in systemic veins, in the heart, or in the placental-umbilical system) may be warranted. Treatment of thrombotic events in the newborn brain is at the moment limited to heparinization in cardio-embolic stroke and in progressive sinovenous thrombosis, both in the absence of major brain hemorrhage.