A Retrospective Analysis of Perinatal Stroke: Hemostasis Abnormalities, Neonatal Seizures, Epilepsy Recurrence, and 2-Year Neurological Outcome.

BACKGROUND

Neonatal stroke is a rare but potentially severe condition that may lead to long-term neurological impairment. Several factors may influence both its occurrence and outcomes.

METHODS

In this retrospective, single-center cohort study, 46 neonates diagnosed with perinatal stroke were included. We assessed (1) the prevalence and clinical relevance of hemostatic screening, (2) the occurrence and treatment of acute symptomatic seizures, and (3) long-term outcomes such as epilepsy, cerebral palsy, and developmental impairment.

RESULTS

A total of 46 patients were included, of whom 24 were preterm, and 22 were term. Coagulation screening was performed in 38 patients, revealing abnormal values in 8 cases. Continuous electroencephalography (EEG) monitoring was conducted in 40 patients, with 26 exhibiting neonatal seizures. Epilepsy developed in five children before the age of 2 years. Neurodevelopmental assessment was performed in 31 children, of whom 13 showed signs of developmental delay.

DISCUSSION: Few patients had abnormal hemostatic tests. These findings were difficult to interpret due to confounding factors, and the literature shows no association with recurrence. Therefore, routine screening is not currently recommended. Seizures occurred mainly in term infants with neonatal arterial ischemic stroke, usually controlled with one antiseizure medication. Prolonged treatment did not prevent epilepsy. Some developed epilepsy before age 2, at lower rates than reported, possibly due to limited follow-up. Developmental impairment was seen in a minority, mostly term infants. Status epilepticus did not affect outcome. Prospective studies with longer follow-up are needed to identify prognostic markers and guide personalized care.