Cerebral Infarction as Multifocal Clonic Seizures in a Term Neonate

Abstract

Background: The incidence of neonatal stroke in full-term infants has been cautiously estimated as 1:10,000, but infants can initially have few symptoms, and the condition has the potential for underdiagnosis. Follow-up studies of known full-term neonatal stroke victims beyond 3 years of age indicate that most develop some form of hemiparesis, seizure disorder, cognitive difficulties, or developmental delay during childhood.

Methods: The case of a full-term infant who had a left middle cerebral artery infarction and who developed multifocal clonic seizures 9 hours after delivery is described and discussed.

Results: Head sonograms first showed evidence of disease when the infant was 72 hours old. Computed tomography (CT) of the head when the infant was 82 hours old showed an ischemic infarction in the distribution of the left middle cerebral artery. Subsequent magnetic resonance angiography showed a resolving embolus in the left middle cerebral artery.

Conclusions: Serial sonograms and CT scans of the infant's head, along with magnetic resonance angiography, were useful in making the diagnosis of cerebral infarction. A late intrauterine placental thromboembolus was the most likely cause. Maternal history of a previous cesarean section could be a risk factor. More studies are needed to define the incidence of this disease and to describe the risk factors.