Neonate (newborn) Strokes

The reasons why babies have strokes differ from why adults have strokes. This video will take you through an example of a baby having a suspected stroke and the steps to diagnose and treat the condition.
This video is provided for general information only. It does not replace a diagnosis or medical advice from a healthcare professional who has examined your child and understands their unique needs. Please speak with your doctor to check if the content is suitable for your situation.
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This is Kate. Kate is one day old. A day after Kate was born, the nurse noticed twitching in her left arm and leg while she was awake. This lasted almost 30 seconds. Doctors assessed the situation. Kate's parents were told that these twitches could be seizures. Kate was then referred to SickKids.
The doctors ordered a picture of her brain. This is called a brain MRI. MRI stands for magnetic resonance imaging. An MRI takes pictures of the structures inside the brain. It is safe, painless and doesn't use radiation. To get a good picture, Kate must lie still and may need medication to sleep during the scan. Kate's MRI showed that she had an arterial ischemic stroke. If the stroke is believed to have happened around the time of birth and presents with symptoms such as seizures in the first 28 days of life, this is called a neonatal arterial ischemic stroke or NAIS for short. An arterial ischemic stroke occurs when the blood flow to a part of the brain is blocked, usually because of a clot in the blood vessels called arteries that supply nutrients and oxygen to the brain. This causes damage to the brain. Sometimes, the child will only show symptoms several months after birth, such as an early hand preference. We call this a presumed perinatal arterial ischemic stroke or PPAIS for short.
Most people may not know that strokes can happen in babies and children. The reasons why babies and children have strokes differed from why adults have strokes.
Recent data for strokes in babies suggests that the risk is 1 to 1,000 live births. In order to figure out why Kate had a stroke, the doctors looked at her heart and arteries, and they tested her blood to look for clotting problems. If these tests are normal, the most likely explanation for the stroke is a clot that travelled from the mother's placenta through the heart and up to the baby's brain before, around or just after the time of birth. There is nothing that Kate's mom could have done differently to prevent this. And the chances of another stroke is less than 1%. Fortunately, the newborn brain is adaptable and can respond to a stroke different to an adult brain, this is called neuroplasticity.
Because of neuroplasticity, Kate is expected to reach developmental milestones. This may be at a different pace than her peers and she may require some extra help. Depending on the location of the stroke, it is possible that Kate may have some challenges, possibly with weakness on one side of the body, language skills, seizures or learning and behaviour.
At SickKids, we have seen many kids like Kate, and we've learned that a majority of children will walk by age two. They will go to school and engage in everyday activities, though some help may be necessary. The doctors may diagnose Kate with cerebral palsy. This is an umbrella term used to describe many symptoms like weak or stiff muscles or poor coordination which result from an injury to the brain around the time of birth. The stroke will not worsen over time. We use this term so that others recognize the challenges that these children face in their day-to-day lives and help to ensure that they receive the appropriate support. Kate will remain connected with the stroke team after she goes home from the hospital and receive the necessary rehabilitation therapies like physiotherapy, speech-language or occupational therapy to reach her full potential.
Please visit the AboutKidsHealth website and search stroke in newborns to learn more.
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