Characteristics of neonatal-onset and presumed neonatal arterial ischemic stroke

Objective: To clarify the difference in clinical-radiological features between neonatal-onset arterial ischemic stroke (AIS) and presumed neonatal AIS with a normal neonatal neurological history. Methods: Twenty-one neonatal AIS patients and seven with presumed neonatal AIS were identified in Aichi Prefecture, Japan, between 2010 and 2014. MRI and clinical characteristics were determined. Results: Nine patients (43 %) with neonatal AIS and only one patient (13 %) with presumed neonatal AIS underwent emergency cesarean sections (ECS). Pyramidal tract involvement was more common in patients with presumed neonatal AIS (71 %) than in those with neonatal AIS (24 %). The most common sequela, hemiplegia, was present in 33 % of patients with neonatal AIS and 71 % with presumed neonatal AIS. Conclusions: The small number of ECS in presumed neonatal AIS suggests different causal factors from those of neonatal AIS. Given the different distributions of lesions and sequelae, there can be undiagnosed patients with presumed neonatal AIS and no sequelae.