Diagnostic management of neonatal stroke

SummaryIn this paper the clinical presentation of neonatal arterial ischaemic stroke (NAIS) and neonatal cerebral sinovenous thrombosis (NCSVT) is briefly summarised; then a structured hierarchical diagnostic flow is proposed to discern clinical phenotypes underlying neonatal (ischaemic as well as haemorrhagic) stroke. The diagnostic flow proposed following clinical detection or chance imaging finding is an initial step towards standardisation of the mechanisms leading to stroke. For NAIS the sequence is: infection, trauma, embolism, arteriopathy, other, primary thrombosis and unclassified; for NCSVT the sequence is: infection, trauma, venopathy, other, primary thrombosis and unclassified. Such standardisation should guide attempts at prevention and treatment. The analysis of a retrospective personal cohort of 134 newborn infants with stroke, suggest that–for stroke in general–embolism is the most common identifiable mechanism (25%), preceding trauma (10%) and infection (8%). For NAIS the presence of an embolic phenotype is 33% in this cohort. The designation unclassifiable scored 34% for the entire stroke group, 25% for neonatal arterial ischaemic stroke. Complex arterial stroke, with multiple arteries involved–is regularly seen following embolism, infection and cranial trauma.