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When a child is born with cerebral palsy, the exact causes are not always known. Ultimately, the cause is abnormal development in the brain, which can be triggered by a variety of factors. One factor is disrupted blood flow to the brain, and a stroke can be the cause of this disruption. A perinatal stroke, one that occurs in the womb or within the first month after birth, can cause brain damage that leads to cerebral palsy.
The signs of a stroke in a fetus or newborn may not be obvious and the possible complications are wide-ranging. This is a common cause of cerebral palsy, but not all neonatal strokes will result in this condition. Other possible complications include learning, language, and behavior issues, epilepsy, and vision problems. 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 occur in a fetus or in a newborn infant. 
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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.
Signs of Perinatal Stroke
An infant may show no signs that it has had a stroke either in the womb or soon after birth. For those that do show signs, seizures are the most common of these. A seizure in an infant may look like twitching in the arms, legs, or face, jerking movements, or pausing breathing and staring.
An infant that experienced a stroke may also show signs of extreme sleepiness or may show weakness or paralysis on one side of the body. 
If signs in infancy are mild or go unnoticed, other signs may show up as the child grows older. These include numbness, weakness, or paralysis on one side of the body, difficulty moving, poor coordination, delays in speech, and other signs of developmental delay. Seizures can also be a sign that a child experienced a perinatal stroke.
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 a perinatal stroke is largely unknown. For most infants, the cause isn’t determined, but there are some risk factors that have been identified in research. One of these is congenital heart disease, which seems to play a role in more than 20 percent of cases of perinatal stroke.
Other risk factors include infections, blood clotting disorders, and placental disorders. There is some evidence that birth trauma, such as asphyxiation, may contribute to perinatal strokes.
When the signs of a stroke are obvious and diagnosis of stroke is made, treatment can be administered 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, 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 a period of up to 72 hours. It has been shown in some studies to reduce fatality rates and resulting brain damage and neurological impairments.
Treatment for perinatal stroke also includes therapies and treatment strategies for the complications that may arise after a stroke. These include physical and occupational therapy, behavioral therapies, educational interventions, the use of assistive devices, medication for seizures, speech therapy, and treatment for vision or hearing impairments. 
About 60 percent of children experiencing a perinatal stroke will end up with some type of neurological or developmental challenge that is permanent. These include epilepsy, behavioral and emotional difficulties, sensory disorders, delays or difficulties with speech and language, hearing and vision problems, learning disabilities, attention deficit hyperactivity disorder, or ADHD, and cerebral palsy.
Perinatal stroke is a common cause of cerebral palsy, although there may be multiple factors that lead to the condition. One study looked at 111 children that had experienced a perinatal stroke and found that 68 percent of them also had cerebral palsy.
Since strokes trigger a loss of blood flow to parts of the brain, this can cause the kind of 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 in the first month of life, there is a good chance that he or she 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 major 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.
- Golomb MR , et al. (n.d.). Cerebral Palsy After Perinatal Arterial Ischemic Stroke. - PubMed - NCBI. National Center for Biotechnology Information.
Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/18305317?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA
- Pediatric Stroke. (2011, June 20). CHASA
Retrieved from: https://chasa.org/medical/pediatric-stroke/
- Harbert MJ , et al. (n.d.). Hypothermia is Correlated with Seizure Absence in Perinatal Stroke. - PubMed - NCBI. National Center for Biotechnology Information.
Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/21700899