title: Top of the basilar artery embolic stroke and neonatal myoclonus.
abstract: Cerebellar stroke has been virtually unreported in the living newborn infant. A term newborn male weighing 3380g at birth suffered myoclonic seizures within 24 hours of birth by spontaneous vaginal delivery. Apgar scores were 3 and 4 at 1 and 5 minutes. Myoclonus persisted for 9 days, responding poorly to step-up anticonvulsant treatment including lidocaine, midazolam, and clonazepam. Imaging documented arterial ischaemic stroke within the left posterior cerebral and both superior cerebellar arteries, compatible with top of the basilar artery stroke. There was no electrographic correlate for the seizures. Disturbed oscillation within the dentato-rubro-olivary circuitry was the likely mechanism. The probable cause was embolism from an in-utero-onset inferior caval vein thrombosis. At 22 months the child was sitting unsupported. Scores on the Bayley Scales of Infant Development II were equivalent to those of a 12-month/year-old. He showed ataxic motor behaviour. Embolism can cause neonatal top of the basilar artery stroke, which may present with myoclonus due to cerebellar injury.
authors.affiliation: Neonatal Intensive Care Unit, Sophia Children's Hospital, Erasmus MC-University Medical Center, Rotterdam, The Netherlands. paul.govaert3@pandora.be
authors.forename: Paul
authors.initials: P
authors.lastname: Govaert
authors.forename: Jeroen
authors.initials: J
authors.lastname: Dudink
authors.forename: Gerhard
authors.initials: G
authors.lastname: Visser
authors.forename: Petra
authors.initials: P
authors.lastname: Breukhoven
authors.forename: Sampsa
authors.initials: S
authors.lastname: Vanhatalo
authors.forename: Maarten
authors.initials: M
authors.lastname: Lequin
mesh_terms: D001488:Basilar Artery / Q000503:physiopathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D004569:Electroencephalography / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D020766:Intracranial Embolism / Q000150:complications*; D008297:Male; D009207:Myoclonus / Q000209:etiology* / Q000473:pathology; D020521:Stroke / Q000150:complications* / Q000473:pathology*