What Is a Stroke?
A stroke is a biological event that occurs when the blood supply to the parts of the brain is interrupted, even for a brief second. There are two types of stroke; one is ischemic, and the other is hemorrhagic stroke. Ischemic stroke is when there is a blockage in the blood supply to the brain, causing the brain cells to die, permanently damaging the brain, and causing a person's body to no longer function normally.
A hemorrhagic stroke occurs when a blood vessel in the brain ruptures, which causes blood to leak all over the brain and damage brain cells. Strokes in babies often occur between the 28th week of pregnancy, before birth, and one month after birth. It may be difficult to identify the stroke symptoms in babies as they may appear generally unwell, drowsy, or have seizures.
What Is a Neonatal Stroke?
Neonatal stroke is a stroke in newborns occurring between the 28th week of pregnancy, before birth, and one month after birth. The neonatal stroke occurrence rate is approximately 1 in 4,000 babies and is even more commonly seen in premature babies. However, the actual rate of occurrence may be higher because of the difficulty of detecting a stroke in newborns. Most often, neonatal stroke is found shortly after birth in babies who are weak and unresponsive or have seizures and confirmed through neuroimaging. There are two main types of early childhood stroke, each with its own effects, causes, and implications for treatment. These are:
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Childhood Stroke - It occurs in newborns from four weeks to 18 months old.
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Perinatal Stroke or Neonatal Stroke - They occur during the time surrounding the birth or four weeks after the birth. They commonly happen due to the baby's blockage or shortage of oxygen while the baby travels through the birth canal.
What Are the Causes of Neonatal Stroke?
Several different causes and factors can lead to a neonatal stroke. Determining the exact cause of a stroke in a newborn can be difficult. One of the most common causes is hypoxia, which happens when a baby is deprived of oxygen leading to irregular activity in the baby's brain. The overall health of the mother also plays a key role in determining whether or not the baby might experience a stroke. Certain problems affecting a mother during pregnancy can also lead to stroke in the baby before or after birth, which include:
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Preeclampsia (high blood pressure during pregnancy).
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Premature membrane rupture (when a mother's water breaks 24 hours before labor starts).
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Coagulation disorders.
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Infections.
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Heart diseases.
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Autoimmune disorders.
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Drug abuse.
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Placenta problems such as placental abruption can decrease the baby's oxygen supply.
Neonatal ischemic strokes are usually related to:
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Oxygen deprivation during birth.
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Presence of heart defect.
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Dehydration.
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Injury to an artery in the brain.
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Blood disorders such as sickle cell anemia.
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Genetic disorders.
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Infection, such as chickenpox or meningitis.
Neonatal hemorrhagic strokes can be caused by:
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A head injury resulting in a broken blood vessel.
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Aneurysm (abnormal bulge or ballooning of a blood vessel)
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Arteriovenous malformation (an abnormal connection of blood vessels connecting arteries and veins).
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Blood clotting disorders such as hemophilia.
What Are the Symptoms of Neonatal Stroke?
Infants often do not show noticeable signs that they are experiencing a neonatal stroke. It can even take several months to detect a neonatal stroke in babies. The symptoms of stroke would get noticed only as the child gets older. The symptoms would include difficulties with speech and balance. Only in the case of a seizure an outward symptom of a neonatal stroke can be noted. However, symptoms of seizures can be pretty hard to find out in newborns. These symptoms include
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Difficulties in facial movements such as chewing, eye movement, or sucking.
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Movements that resemble pedaling or bicycling.
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Staring.
Other common signs of neonatal stroke include:
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Extreme sleepiness and lethargy.
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feeding difficulties
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Numbness or weakness along one side of the body (hemiparesis).
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Apnea (temporary stopping of breathing).
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Neurological impairment.
What Is the Diagnostic Procedure for Neonatal Stroke?
The diagnosis of neonatal and early childhood strokes can be difficult to diagnose if the baby has no signs or symptoms. In a few cases, a stroke may be identified only after ruling out the cause of seizures or developmental delays. This means many tests would have been done to determine the cause, that is, stroke. In some cases, the stroke can be detected while the baby is in the womb. This usually occurs if there is a birth defect and a fetal MRI is suggested for diagnostic purposes.
The following are the tests carried out in babies if the stroke is suspected:
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Blood tests.
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Magnetic resonance imaging (MRI).
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Magnetic resonance angiography (MRA).
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Magnetic resonance venography (MRV).
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Computed tomography scan (CT scan).
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Computed tomography angiography (CTA).
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Cranial ultrasound.
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Lumbar puncture.
What Is the Treatment for Neonatal Stroke?
While treating acute neonatal stroke, quick access to clot-busting medicine, such as tissue plasminogen activator (tPA), is the first treatment for the child. This treatment aids in clearing the blockage in the vessels and limits the effect of stroke on the brain. This drug should be administered within the first 4.5 hours after the onset of symptoms. In some serious situations, endovascular thrombolysis may be performed, which involves navigating a very small catheter directly into the blood clot area and delivering thrombolytic drugs like tPA.
The above-mentioned is the conventional method of stroke treatment. The novel method includes therapeutic hypothermia and hyperbaric oxygen therapy.
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Therapeutic Hypothermia - It is also referred to as brain cooling. In this therapy, the brain's temperature is lowered, which slows down the brain's activity to prevent any further damage to it. Also, it prevents the brain from overheating, resulting in increased blood flow and reduced damage.
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Hyperbaric Oxygen Therapy - In this therapy, the infant is kept in a pressurized room consisting of 100 percent oxygen. Pressurization allows the baby to inhale more oxygen than is kept in regular air pressure conditions. This can help make up for lost oxygen.
Conclusion:
The diagnosis of the condition is a complicated task, as the symptoms in infants are hard to differentiate. However, rapid diagnosis is required to prevent brain damage. Therapeutic innovations like hypothermia and hyperbaric oxygen therapy are very effective treatments and offer good prognosis in patients affected by stroke.
