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Neonatal Stroke - Causes, Symptoms, Diagnosis, and Treatment

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Strokes experienced by infants between the 28th week of pregnancy and one month after birth are called neonatal strokes. Read this article to know more.

Written by

Dr. Asha. C

Medically reviewed by

Dr. Bhaisara Baraturam Bhagrati

Published At March 10, 2023
Reviewed AtFebruary 27, 2024

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:

  • Childhood Stroke - It occurs in newborns from four weeks to 18 months old.

  • 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:

  • Preeclampsia (high blood pressure during pregnancy).

  • Premature membrane rupture (when a mother's water breaks 24 hours before labor starts).

  • Diabetes.

  • Coagulation disorders.

  • Infections.

  • Heart diseases.

  • Autoimmune disorders.

  • Drug abuse.

  • Placenta problems such as placental abruption can decrease the baby's oxygen supply.

Neonatal ischemic strokes are usually related to:

  • Oxygen deprivation during birth.

  • Presence of heart defect.

  • Dehydration.

  • Injury to an artery in the brain.

  • Blood disorders such as sickle cell anemia.

  • Genetic disorders.

  • Infection, such as chickenpox or meningitis.

Neonatal hemorrhagic strokes can be caused by:

  • A head injury resulting in a broken blood vessel.

  • Aneurysm (abnormal bulge or ballooning of a blood vessel)

  • Arteriovenous malformation (an abnormal connection of blood vessels connecting arteries and veins).

  • 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

  • Difficulties in facial movements such as chewing, eye movement, or sucking.

  • Movements that resemble pedaling or bicycling.

  • Staring.

Other common signs of neonatal stroke include:

  • Extreme sleepiness and lethargy.

  • feeding difficulties

  • Numbness or weakness along one side of the body (hemiparesis).

  • Apnea (temporary stopping of breathing).

  • 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:

  • Blood tests.

  • Magnetic resonance imaging (MRI).

  • Magnetic resonance angiography (MRA).

  • Magnetic resonance venography (MRV).

  • Computed tomography scan (CT scan).

  • Computed tomography angiography (CTA).

  • Cranial ultrasound.

  • 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.

  • 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.

  • 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.


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.

Frequently Asked Questions


How Is A Neonatal Stroke Treated?

The treatment of neonatal stroke depends on the severity and circumstances. Supportive care, medications, and rehabilitation therapies may manage symptoms and aid in recovery.


Can A Newborn Fully Recover From A Stroke?

Yes, newborns can fully recover from a stroke. Recovery from neonatal stroke depends on the severity and location of the brain injury. Infants can regain lost functions and achieve developmental milestones with appropriate intervention, rehabilitation, and care.


What Is The Classification Of A Neonatal Stroke?

Neonatal stroke can be classified into two main types: 
- Arterial Ischemic Stroke (AIS): It occurs when there is a blockage or obstruction in an artery that supplies blood to the brain.
- Cerebral Sinovenous Thrombosis (CSVT): It involves the formation of blood clots in the veins that drain blood from the brain.


What Happens If A Newborn Has A Stroke?

Newborns who experience a stroke may exhibit neurological symptoms such as seizures, feeding difficulties, lethargy, abnormal muscle tone, developmental delays, or weakness on one side of the body.


How Long Does It Take To Recover From A Childhood Stroke?

The recovery timeline for childhood stroke varies based on the individual and the extent of the brain injury. Some recover within months, while others require longer rehabilitation. Recovery can be lifelong, and ongoing therapies may be needed for optimal outcomes.


How Serious Is A Stroke In A Child?

Childhood stroke is a serious medical condition with potential long-term physical, cognitive, and developmental challenges. The impact varies based on the location and severity of the brain injury. Early diagnosis, proper treatment, and comprehensive rehabilitation can improve outcomes and reduce complications.


What Is Neonatal Brain Damage?

Neonatal brain damage is an injury or abnormality affecting a newborn's brain, caused by factors like birth trauma, oxygen deprivation, infections, genetic conditions, or strokes. It can result in developmental, cognitive, and physical impairments depending on the extent and location of the damage.


What Is The Risk Of Stroke After Childbirth?

Postpartum stroke carries some risk. High blood pressure, preeclampsia, gestational diabetes, smoking, obesity, and certain medical conditions can increase the risk. Monitoring and managing these factors during pregnancy and the postpartum period is crucial.


Can A Baby Survive A Stroke?

Babies can survive a stroke, especially with medical intervention and appropriate supportive care. The prognosis and long-term outcomes depend on the severity of the stroke, the location of the brain injury, and the effectiveness of the treatment provided.


What Are The Early Treatments To Prevent Neonatal Stroke?

Early treatments to prevent neonatal stroke involve managing maternal health conditions, minimizing blood clot risk, maintaining a healthy lifestyle, and attending regular prenatal check-ups.


What Are The Causes Of Early Neonatal Death?

Causes of early neonatal death include:
- Childbirth complications
- Prematurity
- Birth defects, infections
- Other medical condition


What Is Considered The Early Neonatal Age?

The early neonatal age refers to the period from birth to the first 28 days of life. Early neonatal age is crucial as newborns transition from the womb to the external environment and adjust to their new surroundings.


Is Neonatal Death Common?

Neonatal death is rare in developed countries with advanced healthcare systems but remains challenging in low-income settings. Global efforts focus on improving neonatal care to reduce mortality rates.


What Are The Risk Factors For Neonatal Death?

Neonatal death risk factors include:
- Premature birth
- Low birth weight
- Birth defects
- Maternal complications
- Infections
- Limited healthcare access
- Socio-economic disparitie


What Are The Long-term Effects Of Neonatal Stroke?

Long-term effects of neonatal stroke vary based on severity and location. Physical impairments, cognitive delays, learning disabilities, speech difficulties, and behavioral challenges may occur. However, with proper intervention and support, children can progress and achieve positive outcomes.
Dr. Bhaisara Baraturam Bhagrati
Dr. Bhaisara Baraturam Bhagrati



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