Neonatal Stroke

Strokes in neonates have a much more subtle presentation and can be clinically silent. The most common presenting feature in the neonatal period is a seizure, although some present with nonfocal hypotonia or encephalopathy (8,60 ). Although neonatal seizures due to systemic abnormalities or global brain injury tend to be multifocal or myoclonic, those associated with stroke tend to be persistently focal motor, often involving only one upper extremity.

Neonates rarely have a clinically apparent hemiparesis, even with a large hemispheric stroke. However, those with no clinical manifestations at the stroke ictus may present in later infancy with pathologic early handedness (before one year of life), growth asymmetry, or hand dystonia. A spastic hemiparesis may evolve over time, and some children may meet criteria for "hemiplegic cerebral palsy" (61,62). Others, however, may go undiagnosed until they have a seizure later in life.

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