Neonatal stroke and intracranial haemorrhage

Overview & Definition

A neonate who presents with a focal seizure, hand-preference, or unexplained encephalopathy may have sustained a cerebrovascular injury around the time of birth. The 2007 NICHD-NINDS workshop defined perinatal stroke as a group of cerebrovascular events occurring between 20 weeks of fetal life and 28 days postnatal, and it distinguished several distinct entities that share a narrow time window but differ in mechanism, vessel involvement, and outcome. [1]

Perinatal arterial ischaemic stroke (PAIS) is a focal arterial infarction of the brain confirmed by neuroimaging, occurring in the perinatal period and producing a focal neurological deficit or seizures. Cerebral sinovenous thrombosis (CSVT) is thrombosis of the cerebral venous sinuses or deep veins. Neonatal haemorrhagic stroke is a non-traumatic, intracranial haemorrhage — subdural, subarachnoid, parenchymal or intraventricular — that produces acute neurological dysfunction. [1] [2]

In the preterm infant, the dominant cerebrovascular lesion is germinal matrix-intraventricular haemorrhage (GMH-IVH), originating in the fragile capillary bed of the subependymal germinal matrix, with potential extension into the ventricle and the periventricular white matter. This entity, graded by the Papile system, carries its own pathophysiology and its own principal complication — post-haemorrhagic ventricular dilation (PHVD). [4] [5]

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1. [1]Raju TN; Nelson KB; Ferriero D; Lynch JK Ischemic perinatal stroke: summary of a workshop sponsored by the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke. Pediatrics, 2007.PMID 17766535
2. [2]Cole L; Dewey D; Letourneau N; Kaplan BJ; Chaput K; Gallagher C; Husein M; Mackie M; Mohammed N; Yager JY; et al Clinical Characteristics, Risk Factors, and Outcomes Associated With Neonatal Hemorrhagic Stroke: A Population-Based Case-Control Study. JAMA Pediatr, 2017.PMID 28114647
3. [3]Baak LM; van der Aa NE; Verhagen AAE; Dudink J; Groenendaal F Early predictors of neurodevelopment after perinatal arterial ischemic stroke: a systematic review and meta-analysis. Pediatr Res, 2023.PMID 36575364
4. [4]Ballabh P Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatr Res, 2010.PMID 19816235
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7. [7]Steggerda SJ; De Bruïne FT; van den Berg-Huysmans AA; Rijken M; Leijser LM; Walther FJ; van Wezel-Meijler G Small cerebellar hemorrhage in preterm infants: perinatal and postnatal factors and outcome. Cerebellum, 2013.PMID 23653170
8. [8]Greenham M; Knight S; Rodda J; Scheinberg A; Anderson V; Mackay MT Australian clinical consensus guideline for the subacute rehabilitation of childhood stroke. Int J Stroke, 2021.PMID 32691701
9. [9]Wagenaar N; Baak LM; van der Aa NE; Groenendaal F; Dudink J Perinatal Arterial Stroke Treated With Stromal Cells Intranasally: 2-Year Safety and Neurodevelopment. Stroke, 2025.PMID 40654084