The images to the left are of an infant who presented on the second day of life with a clear history of focal right sided seizures.  These did not require treatment with anticonvulsant medication.

Ultrasound scans, whilst good for looking for haemorrhage and gross structural abnormalities, are less sensitive for looking at infarctions.  If a neonatal stroke is suspected, then further imaging with either CT or MRI is indicated regardless of the result of the ultrasound scan.

In the images to the left, the ultrasound scans show a subtle difference between the left and right sides, with loss of gyral definition and some increased echogenicity on the left.  The CT scans demonstrate an extensive infarction in the left parietal region.

The aetiology of neonatal stroke is unclear.  There is an association both with perinatal asphyxia and birth trauma.  Inherited thrombophilic conditions have been implicated, as have cardiac diseases and vascular malformations within the brain.  In a large number of cases, however, no cause is identified.

Outcome is variable and depends on extent and location of the lesion.  Most commonly, if children have long-term sequelae they will manifest a degree of hemiplegia.

Recurrence risk is low (<5%).