title: Perinatal ischemic stroke: a five-year retrospective study in a level-III maternity.
abstract: OBJECTIVE
  To study the incidence, clinical presentation, risk factors, imaging diagnosis, and clinical outcome of perinatal stroke.
  
  
  METHODS
  Data was retrospectively collected from full-term newborns admitted to the neonatal unit of a level III maternity in Lisbon with cerebral stroke, from January 2007 to December 2011.
  
  
  RESULTS
  There were 11 cases of stroke: nine were arterial ischemic stroke and two were cerebral venous sinus thrombosis. We estimated an incidence of arterial ischemic stroke of 1.6/5,000 births and of cerebral venous sinus thrombosis of 7.2/100,000 births. There were two cases of recurrent stroke. Eight patients presented with symptoms while the remaining three were asymptomatic and incidentally diagnosed. The most frequently registered symptoms (8/11) were seizures; in that, generalized clonic (3/8) and focal clonic (5/8). Strokes were more commonly left-sided (9/11), and the most affected artery was the left middle cerebral artery (8/11). Transfontanelle ultrasound was positive in most of the patients (10/11), and stroke was confirmed by cerebral magnetic resonance in all patients. Electroencephalographic recordings were carried out in five patients and were abnormal in three (focal abnormalities n=2, burst-suppression pattern n=1). Eight patients had previously identified risk factors for neonatal stroke which included obstetric and neonatal causes. Ten patients were followed up at outpatients setting; four patients developed motor deficits and one presented with epilepsy.
  
  
  CONCLUSIONS
  Although a modest and heterogeneous sample, this study emphasizes the need for a high level of suspicion when it comes to neonatal stroke, primarily in the presence of risk factors. The prevalence of neurological sequelae in our series supports the need of long-term follow-up and early intervention strategies.
authors.affiliation: Maternidade Dr. Alfredo da Costa, Lisboa, Portugal.
authors.forename: Virgínia
authors.initials: V
authors.lastname: Machado
authors.affiliation: Maternidade Dr. Alfredo da Costa, Lisboa, Portugal.
authors.forename: Sónia
authors.initials: S
authors.lastname: Pimentel
authors.affiliation: Maternidade Dr. Alfredo da Costa, Lisboa, Portugal.
authors.forename: Filomena
authors.initials: F
authors.lastname: Pinto
authors.affiliation: Maternidade Dr. Alfredo da Costa, Lisboa, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Nona
mesh_terms: D000367:Age Factors; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D001938:Brazil / Q000453:epidemiology; D004453:Echoencephalography; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors