Skip to Main Content




Neonatal stroke is estimated to occur in 1 per 2300 to 5000 live births.1 This estimate may be an underrepresentation of the true incidence of neonatal stroke because of the inherent challenges in diagnosing this condition. In the adult, stroke is defined as “rapidly developed signs of focal (or global) disturbance of cerebral function lasting greater than 24 hours (unless interrupted by surgery or death), with no apparent nonvascular cause.”2 In this definition, there is heavy reliance on the clinical signs of neurological dysfunction. These signs are not usually apparent in the neonate because motor dysfunction is not easily appreciated, and sophisticated repertoires of behaviors such as language or the ability to follow commands have not yet developed. In the newborn, symptoms are vague, including encephalopathy, seizures, hypotonia, poor feeding, and apnea. This list of symptoms may be present in many of the diseases treated in the neonatal intensive care unit; therefore, trying to ascertain which are caused by stroke can be immensely challenging. The correct identification of stroke, however, is paramount for many reasons, ranging from identifying potentially modifiable risk factors to acute therapeutic intervention (particularly for sinus venous thrombosis). Managing long-term outcomes, which tend to be poor, is difficult but may improve with aggressive early intervention and emerging therapies such as transcranial magnetic stimulation and constraint-induced therapy.


In neonates, a proposed definition of stroke is as follows: “A group of heterogeneous conditions in which there is a focal disruption of cerebral blood flow secondary to arterial or venous thrombosis or embolization, between 20 weeks of fetal life through the 28th post-natal day, and confirmed by neuroimaging or neuropathological studies.”3 In this definition, there is a conspicuous absence of any clinical sign or physical exam finding suggesting neurologic dysfunction caused by stroke. As in adults, stroke in neonates can be subcategorized based on the affected vascular distribution (arterial vs venous), by whether the primary mechanism is ischemic or hemorrhagic, and by the presumed timing of the event (prenatal or postnatal). In this chapter, arterial ischemic stroke is discussed first, followed by venous stroke (better known as cerebral venous sinus thrombosis, CVST), and then hemorrhagic stroke. Prenatal and perinatal ischemic events defined by the term presumed perinatal ischemic stroke (PPIS) are also discussed.






Arterial ischemic stroke occurs when an arterial vessel is occluded by a thrombus or an embolus, resulting in ischemic injury to the brain tissue distal to the occlusion. A thrombus is defined as a clot that is adherent to the wall of a vessel, whereas an embolus is a nonadherent thrombus. The embolus may be moving within arterial vessels or venous vessels or may become paradoxical by crossing from venous to arterial circulation. Paradoxical emboli may be more likely to occur in the neonate as right-to-left shunts are a necessary part of cardiovascular physiology during the transition ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


Create a Free MyAccess Profile

* Required Fields

Note: If you have registered for a MyAccess profile on any of the Access sites, you can use the same MyAccess login credentials across all sites.

Passwords must be between 6 and 40 characters long (no whitespace), cannot contain characters #, &, and must contain:
  • at least one lowercase letter
  • at least one uppercase letter
  • at least one digit

Benefits of a MyAccess Profile:

  • Remote access to the site off-campus on any device
  • Notification of new content via custom alerts
  • Bookmark your favorite content such as chapters, figures, tables, videos, cases and more
  • Save and download images to PowerPoint
  • Self-Assessment quizzes saved for quick review
  • Custom Curriculum access for both instructors and learners

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.