title: Risk factors, clinical presentation, and neuroimaging findings of neonatal perforator stroke.
abstract: OBJECTIVE
  To date, studies on neonatal stroke have mainly focused on cortical stroke. We have focused on perforator strokes, noncortical strokes in the arterial vascular perforator area. We sought to identify risk factors and evaluate clinical presentation and neuroimaging findings for neonatal perforator stroke, which seems to be under-recognized.
  
  
  METHODS
  All infants admitted to our tertiary intensive care unit in ≈12 years, whose perforator stroke was diagnosed with postnatal brain imaging, were enrolled in this study. Demographic, perinatal, and postnatal data were evaluated.
  
  
  RESULTS
  Seventy-nine perforator strokes were detected in 55 patients (28 boys), with a median gestational age of 37 1/7 weeks (range 24 1/7 to 42 1/7 weeks, 25 preterm). Perforator stroke was asymptomatic in most patients (58%). Initial diagnosis was predominantly made with cranial ultrasound (80%) in the first week of life (60%). Risk factors for stroke were present in all cases: maternal, fetal, and perinatal. Likely pathogenic mechanisms were prolonged birth asphyxia (16%), hypoxia or hypotension (15%), embolism (15%), infection (15%), acute blood loss (9%), and birth trauma (9%).
  
  
  CONCLUSIONS
  Previously described risk factors for developing neonatal main artery stroke are probably also associated with neonatal perforator stroke. Perforator stroke is often asymptomatic, but cranial ultrasound is a reliable diagnostic tool in diagnosing perforator stroke.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Ginette M
authors.initials: GM
authors.lastname: Ecury-Goossen
authors.forename: Marlou M A
authors.initials: MM
authors.lastname: Raets
authors.forename: Maarten
authors.initials: M
authors.lastname: Lequin
authors.forename: Monique
authors.initials: M
authors.lastname: Feijen-Roon
authors.forename: Paul
authors.initials: P
authors.lastname: Govaert
authors.forename: Jeroen
authors.initials: J
authors.lastname: Dudink
mesh_terms: D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D007363:Intensive Care Units, Neonatal; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D014463:Ultrasonography
keywords: neonatal stroke; risk factors; ultrasound