KIDS HAVE STROKES 

Risk Factors Associated with Perinata Stroke, Neonatal Strokel or Stroke in Infants

Journal Articles

Also see Conditions Associated with Stroke in Children (between 1 month and 18 years of age)

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Perinatal Stroke involves an often poorly understood neurological events affecting the fetus and the newborn with a potential for serious neurological outcome. 

Perinatal arterial ischemic stroke is the most common known cause of cerebral palsy in term and near-term infants.  Perinatal stroke is seventeen times more common than pediatric stroke beyond the newborn period.  Arterial ischemia occurring during the 3 days surround birth is reported to be responsible for 50% to 70% of congenital hemiplegic cerebral palsy.

What causes a Perinatal Stroke (between 28 weeks gestation to 28 days after birth)?

When we discuss causes of perinatal or infant stroke, we're actually discussing risk factors for perinatal or infant stroke.  A risk factor is something that may increase the likelihood of a disease, condition, or injury.   Listed below are risk factors that may be associated with perinatal or infant stroke.  Even though a risk factor may be identified, this does not necessarily mean that the risk factor is what caused the stroke.

Cardiac disorders including congenital heart disease, patent ductus arteriosus and pulmonary valve atresia.

Blood Disorders due to deficiencies or mutations in coagulation factors and hyperviscocity syndromes which make an infant's blood more likely to clot or hemorrhage.  Blood, homocysteine, and lipid disorders include polycythaemia, disseminated intravascular coagulopathy, Factor-V Leiden mutation, Protein-S deficiency, Protein-C deficiency, Prothrombin mutation, Homocysteine, Lipoprotein (a), and Factor VIII.

Infection leads to a hypercoagulable state and has been found to be a risk factor for cerebrovascular disease.  CNS infection and systemic infection are perinatal risk factors.

Maternal disorders including autoimmune disorders, coagulation disorders, anticardiolipin antibodies, twin to twin transfusion syndrome, in utero cocaine exposure and infection.

Placental disorders including placental thrombosis, placental abruption, placental infection, and fetomaternal hemorrhage.

Vasculopathy including vascular maldevelopment

Trauma and catheterization procedures

Birth asphyxia

Dehydration

Extracorporeal membrane oxygenation

No cause can be detected

Journal Articles

Cerebral palsy secondary to perinatal ischemic stroke. June 2006. Canada. Kirton, A., deVeber, G. Congenital hemiplegia is the most common form of cerebral palsy in children born at term, and stroke is the number one cause. Neonatal ischemic stroke includes perinatal arterial ischemic stroke, presumed pre- or perinatal stroke, and cerebral sinovenous thrombosis, all of which have emerged as important contributors to cerebral palsy. Of increasing interest is how the overlapping list of associations and risks for stroke and cerebral palsy relate to each other. Stroke-induced injury is focal, and the preservation of normal areas of brain may afford unique opportunities for plastic adaptation. The implications of this essential difference are stressed in a discussion of how the epidemiology, pathophysiology, diagnosis, and therapeutic advancements in perinatal stroke relate to the outcome of cerebral palsy.

Pathways of neonatal stroke and subclavian steal syndrome.  May 2006. UK  Case report of neonatal stroke without neurological signs.

Outcomes of children with infantile spasms after perinatal stroke. April 2006. Indiana

Predictors of Outcome in Perinatal Arterial Stroke:  A population-based study Some infants with perinatal arterial ischemic stroke (PAS) experience development of cerebral palsy (CP), epilepsy, and cognitive impairment, whereas others do not. 

Perinatal arterial stroke: understanding mechanisms and outcomes. Arterial ischemic infarction occurring around the time of birth is an increasingly recognized cause of neurological disability in children. The incidence, clinical presentation, pathogenesis, risk factors, and outcome of this increasingly recognized disorder are reviewed.  Wu, YW, Lynch, JK, Nelson, KB. California. Semin Neurol. 2005 Dec;25(4):424-34.

Risk factors for pediatric cerebrovascular disease This article by Dr. E. S.  Roach, lists different types of congenital heart disease, acquired heart disease, hematologic disorders and coagulopathies, systemic vascular disease, vasculitis, structural anomalies of the cerebrovascular system, vasculopathies, vasospastic disorders, and trauma as possible risk factors for pediatric stroke.

Stroke in newborn infants. Nelson, K.B., Lynch, J.K. Maryland, March 2004. The few days before and after birth are a time of special risk for stroke in both mother and infant, probably related to activation of coagulation mechanisms in this critical period. Arterial ischaemic stroke around the time of birth is recognised in about one in 4000 full-term infants, and may present with neurological and systemic signs in the newborn. Neonatal seizures are most commonly the clinical finding that triggers assessment. In other children, perinatal stroke is recognised only retrospectively, with emerging hemiparesis or seizures after the early months of life. Risk factors for perinatal stroke include hereditary or acquired thrombophilias and environmental factors. Perinatal stroke underlies an important share of congenital hemiplegic cerebral palsy, and probably some spastic quadriplegic cerebral palsy and seizure disorders. There is much to be learned about the natural history of perinatal stroke, and there are as yet no evidence-based strategies for prevention or treatment.

Fetal stroke Occurs between 14 weeks of gestation and the onset of labor. This article presents seven cases of fetal stroke diagnosed in utero and reviews 47 cases of fetal stroke in the literature.  March 2004. California.

Symptomatic Ischemic Stroke in Full-Term Neonates

Chorioamnionitis and cerebral palsy in term and near-term infants. May 2004. California. Stanford University School of Medicine.  Ozduman, Ober, Barnes, Copel, Ogle, Duncan, Ment.

Cerebral infarction in perinatal and childhood bacterial meningitis. Oct. 2003. Taiwan. Chang, Huang, Hung, Ho, Wang, Cheng, Lui, Lu.

Is there a genetic basis for pediatric stroke?. Dec. 2003. London. Kirkham.

Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke 2002

Paediatric stroke: case series, June 2002. Hong Kong

Neuropathology associated with stillbirth Feb. 2002; mentions cerebral infarct as one of the abnormalities found in stillborns

Why do newborn infants already suffer from "stroke". Studies of focal, arterial, ischemic infarct 1999

Iron deficiency: a cause of stroke in infants and children. Jan. 1997. Canada.

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