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2024, Number 1

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Rev Mex Pediatr 2024; 91 (1)

Early diagnosis of a neonatal arterial ischemic stroke with cranial ultrasound

Jiménez-Martínez P, Serpa-Maldonado EV, Baena-Jiménez CV, Mantilla-Uresti JG, Guillén-Torres R, Villanueva-García D, Ibarra-Ríos D

Language: Spanish
References: 20
Page: 17-23
PDF size: 450.26 Kb.


ABSTRACT

Introduction: the global incidence of perinatal stroke is one in every 1,100 live births. Ischemic infarction is the most frequent, accounting for 90% of published cases. The most common presentation is focal or generalized seizures (70 to 90% of cases). Clinical case: a 40-week-old female newborn was born from the third pregnancy of a 31-year-old mother. A third-trimester ultrasound was performed reporting a normal fetal Doppler of the left middle cerebral artery (LMCA). An emergency caesarean section due to category II fetal heart rate, meconium-stained fluid, and lack of progression of labor was performed; two cycles of positive pressure ventilation and endotracheal intubation were required; Apgar score was 3, 5, 7. A point of care ultrasound (POCUS) was performed with cranial ultrasound (CU) at two days of age showing with LMCA vasodilation. At 10 days of age, a follow-up POCUS was performed diagnosing a neonatal arterial ischemic stroke (NAIS). At this moment, the neurological examination was normal. A comprehensive approach was performed, ruling out infections, autoimmune disease, and hereditary thrombophilia. Treatment with enoxaparin was prescribed. Seizures occurred until six months of age, and West Syndrome was diagnosed. Conclusions: surveillance in neonate with neurological risk, follow-up by POCUS, even with a normal neurolosgical examination, allows detection of complications such a neonatal arterial ischemic stroke.


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