Clinical Characteristics, Diagnosis and Management of Neonatal Stroke

Background: Neonatal stroke (NS) is a common, severe central nervous system disease that is the main cause of death and disability in neonates. Therefore, great attention has already been paid to it by clinicians. However, much knowledge remains yet to be discovered about this disease. Objectives: To understand the clinical features, increase awareness, reduce missed diagnoses or misdiagnoses, and improve the prognosis of NS. Methods: A retrospective analysis was conducted on clinical data from 51 patients with NS recording perinatal factors, clinical manifestations, imaging findings, and treatment outcomes. Results: 1) Logistic multi-factor regression analysis showed that cesarean section, perinatal hypoxia, small for gestational age and maternal-fetal infection were the main risk factors of NS, 2) A total of 84.3% of the patients presented neurological symptoms or signs, of which 78.4% had convulsions as the primary symptom or major manifestation, and 67.5% had positioning significance, while 15.7% of the patients had no clinical manifestations, 3) Onset of symptoms: 76.7% within 24 hours after birth, 86.0% within 48 hours, 90.7% within 72 hours, and 7.0% after 3 days, with only 2.0% after 7 days, 4) Bilateral hemisphere involvement was present in 49.1% of cases, left hemisphere involvement in 31.4%, right hemisphere and basal ganglia involvement in 19.6% each, 5) The incidence of sequelae in living babies was 45.8%, and the overall rate of a poor prognosis was 49.1%. Conclusions: 1) Convulsion was the most common primary symptom of NS, 15.7% of the patients had no clinical manifestations. 2) The patients had an NS onset within several minutes to hours after birth, with > 75% having an onset within 24 hours, 85% within 48 hours, and > 90% within 72 hours after birth, 3) Caesarean section, perinatal hypoxia and small for gestational age were closely associated with NS, 4) Patients often exhibited bilateral hemisphere injury.