Perinatal stroke is a type of brain injury that occurs in a baby due to reduced blood flow either before or shortly after birth.

A perinatal stroke is a brain injury that occurs between 20 weeks of pregnancy and 28 days after birth, often due to disrupted blood flow or lack of oxygen.

The effects can range from mild to severe and might include problems with movement, thinking, or behavior, which can last throughout a person’s life.

A perinatal stroke can be caused by various factors that disrupt blood flow to the brain before or shortly after birth.

Common causes include:

  • Blood clots or thrombosis: These can block blood vessels, leading to a lack of oxygen and nutrients in the brain.
  • Bleeding in the brain: Conditions such as intracerebral hemorrhage can cause bleeding that damages brain tissue.
  • Problems with blood vessels: Abnormalities or damage in blood vessels can impair normal blood flow.
  • Infections or inflammation: These can affect blood flow and contribute to stroke risk.
  • Birth complications: Issues such as asphyxia, where the baby does not get enough oxygen, can increase the risk of stroke.

Research suggests that risk factors for perinatal arterial ischemic stroke include:

  • emergency cesarean section
  • birth asphyxia (low oxygen before or after birth)
  • low Apgar score (quick assessment of a newborn’s health immediately after birth)

Perinatal stroke is defined as a stroke that occurs after 20 weeks gestation or 28 days after birth. It is nearly impossible to diagnose a fetal stroke prior to 20 weeks gestation.

This term includes several specific types of strokes:

  • Perinatal arterial ischemic stroke (PAIS): Perinatal arterial ischemic stroke (PAIS) is caused by reduced blood flow in the brain’s arteries. It affects about 1 in 4,000 live births and can lead to motor, cognitive, and behavioral complications.
  • Neonatal arterial ischemic stroke (NAIS): NAIS is a subtype of PAIS, specifically referring to strokes that happen within the first 28 days after birth. NAIS occurs when a blockage in a brain artery reduces blood flow and oxygen to the brain. It is more common in preterm infants, particularly those born before 34 weeks, and has a 3% mortality rate.
  • Neonatal hemorrhagic stroke: This condition involves bleeding in the brain, often due to birth trauma or clotting disorders. It occurs in about 1 in 6,300 live births suggests a 2017 population-based study. The research also suggests around 50% of affected infants face outcomes such as delays in movement and sensory skills and epilepsy.
  • Fetal ischemic stroke: This type of ischemic stroke occurs before birth. Healthcare professionals typically use prenatal imaging to detect it.
  • Cerebral sinovenous thrombosis (CSVT): Neonatal CSVT is a rare condition that can cause long-term neurological issues. It occurs when a blood clot forms in the brain’s venous sinuses, blocking blood drainage and raising intracranial pressure. Key risk factors include maternal blood clotting problems, a difficult delivery, lack of oxygen at birth, and needing respiratory support.

Symptoms of a perinatal stroke may include:

  • seizures
  • weakness
  • trouble feeding
  • abnormal muscle tone
  • motor asymmetry
  • developmental delays
  • altered mental status
  • difficulty with coordination
  • respiratory problems

It’s also possible that a baby might be born with obvious symptoms. If the symptoms are mild and affect a skill that’s expected to develop later, such as walking or learning, it might not be detected until later during childhood.

Immediate treatment for perinatal stroke typically focuses on stabilizing the infant and addressing any complications. Key steps include:

  • Supportive care: Ensuring the baby’s basic needs are met, including maintaining proper oxygenation, temperature, and hydration, is the main goal of supportive care.
  • Diagnostic imaging: This process involves conducting imaging studies, such as MRI or CT scans, to confirm the stroke and assess its extent.
  • Monitoring: Continuous monitoring of neurological status, vital signs, and any potential complications, such as increased intracranial pressure, are important steps following a diagnosis.
  • Seizure management: This process mainly involves administering anticonvulsants to control seizures, which are a common symptom of perinatal stroke. These drugs may be used in some cases to prevent future seizures.
  • Anticoagulation therapy: In some cases, if a blood clot is identified as the cause, anticoagulants may be used to prevent further clotting. However, most perinatal strokes are identified too late for these medications to be effective.
  • Physical or occupational therapy: The most common treatments help children adjust to stroke-related limitations. This can include swallow therapy, respiratory assistance, learning assessments, and more.

The outlook for perinatal stroke can vary.

Some retrospective studies show that more than 40% of babies have less optimistic outcomes. However, determining things like mortality rates involves many factors, so it’s best to talk with a doctor to fully understand an individual child’s risk.

A long-term study on perinatal hemorrhagic stroke indicated that while there’s a high mortality rate (20%), most of the surviving babies only had mild or no significant deficits by the time they reached age 1 year.

In general, perinatal stroke can lead to various long-term effects depending on the severity and location of the brain injury. Some long-term effects include:

Recent evidence shows that perinatal strokes, especially those caused by oxygen deprivation around the time of birth, are a significant cause of hemiplegic cerebral palsy (muscle weakness or paralysis on one side).

Some children may not show signs of neurological problems, such as weakness on one side of the body (hemiparesis), until several months after birth, which could be linked to having experienced a perinatal stroke.

A perinatal stroke is a type of brain injury that happens in the very early stages of life, either before birth or shortly after.

Treatment focuses on managing symptoms through therapies, medications, and supportive care. Early intervention can improve outcomes, giving children a better chance for a healthier future.