Paeds Vivas · fetal-neonatal-and-perinatal
Neonatal stroke and intracranial haemorrhage — branching viva
Branching viva from the recognition of perinatal arterial ischaemic stroke through the Papile grading of GMH-IVH, the post-haemorrhagic ventricular dilation decision, and the late-presenting presumed perinatal stroke.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the neonatal registrar on the postnatal ward. The midwife asks you to review three newborns: a term infant with focal seizures on day 2, a preterm infant with a grade III IVH on routine cranial ultrasound, and a 4-month-old referred for early hand-preference. The examiner releases information in stages about each, probing your classification, imaging, and management.
Station opening
Examiner: "Define perinatal stroke and distinguish the main entities within it." [1]
Strong candidate (must-hit)
- Defines perinatal stroke using the Raju 2007 NICHD-NINDS workshop time window (20 weeks fetal to 28 postnatal days), then distinguishes the ischaemic group (perinatal arterial ischaemic stroke, cerebral sinovenous thrombosis) from the haemorrhagic group (neonatal haemorrhagic stroke, germinal matrix-intraventricular haemorrhage), explaining that each has a different mechanism, imaging signature, and management pathway. [1]
Weak candidate
- "A neonatal stroke is a brain bleed in a newborn." [1]
References6ShowHide
- [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
- [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]Ballabh P Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatr Res, 2010.PMID 19816235
- [5]Ballabh P; de Vries LS White matter injury in infants with intraventricular haemorrhage: mechanisms and therapies. Nat Rev Neurol, 2021.PMID 33504979
- [6]de Vries LS; Groenendaal F; Liem KD; Heep A; et al Treatment thresholds for intervention in posthaemorrhagic ventricular dilation: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed, 2019.PMID 29440132
- [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