Cerebral infarctions in the fetus and neonate: maternal-placental-fetal considerations.
Historical data, clinical examination findings, and laboratory information must be integrated along a variable timeline that includes antepartum, intrapartum, and postnatal time periods when cerebral infarction can occur, in the context of the neonates genetic endowment. Genetic susceptibility or prenatal acquired vulnerabilities regarding stroke syndromes may set in motion a cascade of molecular pathways that ultimately cause or exacerbate brain injury when the vulnerable child experiences adverse medical conditions. The clinician must consider maternal, placental, and fetal conditions on which a stroke syndrome may be superimposed, with or without additional brain injury from other pathogenic mechanisms. Evaluation of fetal and neonatal cerebral infarction requires knowledge of mechanisms of brain injury that cross medical disciplines and may involve consultation with maternal/fetal specialists, placental and pediatric pathologists, neonatologists, geneticists, and other pediatric subspecialties. Comprehensive evaluations of survivors of cerebral infarction are needed to better understand structural and functional plasticity of the developing brain after a cerebrovascular event in the fetal and neonatal periods.
Scher
Mark S
MS
Department of Pediatrics, Division of Pediatric Neurology, Fetal and Neonatal Neurology Programs, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH 44106-6005, USA. mss20@po.cwru.edu
Wiznitzer
Max
M
Bangert
Barbara A
BA
D000465:Algorithms; D002544:Cerebral Infarction / Q000151:congenital / Q000175:diagnosis / Q000628:therapy; D002648:Child; D002658:Developmental Disabilities / Q000209:etiology; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D007231:Infant, Newborn; D008431:Maternal-Fetal Exchange; D008487:Medical History Taking; D009473:Neuronal Plasticity; D010922:Placenta Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011247:Pregnancy; D011379:Prognosis; D012017:Referral and Consultation; D012307:Risk Factors; D020521:Stroke / Q000151:congenital / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome