Focal motor seizures heralding stroke in full-term neonates

R. Clancy, S. Malin, D. Laraque, S. Baumgart and D. Younkin

We describe the clinical syndrome, medical management, etiology, and neurologic outcome of stroke diagnosed by computed tomographic scan in 11 full-term neonates encountered during a two-year period. Neonatal stroke is relatively common and may appear in the setting of diverse cerebrovascular disorders such as hypoxic-ischemic encephalopathy, polycythemia, acute severe hypertension, and embolization. Repetitive, persistently unifocal motor seizures heralded localized cerebral injuries in eight infants. The majority of patients did not display any other lateralized clinical neurologic signs. An electroencephalogram revealed a focal or lateralized functional central nervous system abnormality in ten cases. All of the initial computed tomographic scans were focally abnormal. However, cranial ultrasound examinations were insensitive to stroke in nine patients. Medical management included careful cardiorespiratory support, correction of coexisting metabolic or system abnormalities, and aggressive administration of anticonvulsants to promptly eliminate seizures. Limited follow-up suggests that many affected infants may enjoy favorable outcomes.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cerebral Palsy After Perinatal Arterial Ischemic Stroke
Golomb et al.
J Child Neurol 2008;23:279-286.
ABSTRACT  

Epilepsy in Children With Delayed Presentation of Perinatal Stroke
Fitzgerald et al.
J Child Neurol 2007;22:1274-1280.
ABSTRACT  

Independent Walking After Neonatal Arterial Ischemic Stroke and Sinovenous Thrombosis
Golomb et al.
J Child Neurol 2003;18:530-536.
ABSTRACT  

Cranial Ultrasonography Has a Low Sensitivity for Detecting Arterial Ischemic Stroke in Term Neonates
Golomb et al.
J Child Neurol 2003;18:98-103.
ABSTRACT  

Internal Carotid Artery Thrombus: An Underdiagnosed Source of Brain Emboli in Neonates?
Alfonso et al.
J Child Neurol 2001;16:446-447.
ABSTRACT  

Perinatal cortical infarction within middle cerebral artery trunks
Govaert et al.
Arch. Dis. Child. Fetal Neonatal Ed. 2000;82:59F-63.
ABSTRACT | FULL TEXT  

Neonatal focal temporal lobe or atrial wall haemorrhagic infarction
Govaert et al.
Arch. Dis. Child. Fetal Neonatal Ed. 1999;81:211F-216.
ABSTRACT | FULL TEXT  

Early Prognostic Indicators of Outcome in Infants With Neonatal Cerebral Infarction: A Clinical, Electroencephalogram, and Magnetic Resonance Imaging Study
Mercuri et al.
Pediatrics 1999;103:39-46.
ABSTRACT | FULL TEXT  

Unilateral neonatal cerebral infarction in full term infants
Estan and Hope
Arch. Dis. Child. Fetal Neonatal Ed. 1997;76:88F-93.
ABSTRACT | FULL TEXT  

Clinical Significance of Focal Periodic Discharges in Neonates
Scher and Beggarly
J Child Neurol 1989;4:175-185.
ABSTRACT