Perinatal Stroke and Cerebral Palsy

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A perinatal stroke occurs in the womb or within the first month after birth. Perinatal stroke is a leading cause of brain damage that leads to cerebral palsy. Treatment for perinatal stroke varies depending on the complications it has caused.

What Is a Perinatal Stroke?

A stroke is a blockage or breakage of a blood vessel in the brain. An ischemic stroke is a blockage, while a hemorrhagic stroke is a breakage. Both types result in a loss of blood flow to part of the brain.

A perinatal stroke is a stroke that occurs anytime between the middle of pregnancy—around 22 weeks— and the first month of a newborn’s life. This means a perinatal stroke can happen in a fetus or a newborn infant.[1]

Perinatal strokes are varied. They may be ischemic or hemorrhagic. They may affect an artery or a vein. They may occur in the womb or after birth. Most importantly, the symptoms may appear right at birth or not until later, sometimes years later.

Ischemic strokes are most common in the perinatal period, and fortunately, the risk that a child will have another stroke later is low. Perinatal strokes are the most common of pediatric or childhood strokes.

What Are the Signs of Perinatal Stroke?

An infant may show no signs of having a stroke either in the womb or soon after birth. For those that do show symptoms, seizures are the most common. A seizure in an infant may look like twitching in the arms, legs, or face, jerking movements, or pausing breathing and staring.[2]

If signs in infancy are mild or go unnoticed, other symptoms may appear as the child ages. These include numbness, weakness, or paralysis on one side of the body.[3]

How Is Perinatal Stroke Diagnosed?

If signs that seem like a stroke are seen in a newborn, there are diagnostic tests a doctor can do to determine if it is, in fact, a stroke or to rule that out as a possibility. Imaging scans are the best way to see what is happening in the brain and to diagnose a stroke.

A head computed tomography or CT scan of the head gives an image that can show a blockage or bleeding. An MRI or ultrasound may also be used to get an image of the brain.

What Causes Perinatal Stroke?

What causes a perinatal stroke is mainly unknown. For most infants, the cause isn’t determined, but researchers have identified some risk factors. One of these is congenital heart disease.

Other risk factors include infections, blood clotting disorders, and placental disorders. There is evidence that birth trauma, such as asphyxiation, may contribute to perinatal strokes.

Treatments for Perinatal Stroke

When the signs of a stroke are obvious and a diagnosis of stroke is made, doctors can administer treatment as it is happening. There are several possible strategies a doctor may use. Anticonvulsant medicines can be used to limit or stop seizures, for instance.

For a hemorrhagic stroke, surgery to remove the pooling blood and relieve pressure on the brain is often necessary. An infant having a stroke may also be given oxygen and fluids for hydration and blood thinners to prevent or break up blood clots that may be causing an ischemic stroke.

An emerging treatment for stroke in infants is therapeutic hypothermia. This involves cooling the infant’s head for up to 72 hours. Some studies have shown it to reduce fatality rates and resulting brain damage and neurological impairments.[4]

Treatment for perinatal stroke also includes therapies and treatment strategies for complications after a stroke. These include physical and occupational therapy, behavioral therapies, educational interventions, assistive devices, medication for seizures, speech therapy, and treatment for vision or hearing impairments.

Complications of Perinatal Stroke

About 60 percent of children experiencing a perinatal stroke will end up with some neurological deficit, often permanent.[5]

These include weakness on one side of the body, epilepsy, speech and language difficulties, learning and memory deficits, behavioral challenges, ADHD, and cerebral palsy.

Does Perinatal Stroke Cause Cerebral Palsy?

Perinatal stroke is a common cause of cerebral palsy, although multiple factors may lead to the condition. One study looked at 111 children who had experienced a perinatal stroke and found that 68 percent of them also had cerebral palsy.[6]

Since strokes trigger a loss of blood flow to parts of the brain, this can cause brain damage and neurological impairment that leads to muscle, movement, and sensory challenges characteristic of CP.

If your child suffered a stroke in the womb or the first month of life, there is a good chance that they will have cerebral palsy. This is a condition that has a good prognosis despite the lifelong impairments it causes. Advances in treatments and therapies mean that your child can most likely live a normal and long life.

A stroke is a significant cause of CP, and if you believe that your child’s stroke could have been prevented with better medical care, you may be able to make a case with the guidance of the right lawyer and seek compensation for your child.