Perinatal Stroke in a Chinese Neonatal Center: Clinical Characteristics, Long-Term Outcomes, and Prognostic Factors

Objective To assess the clinical characteristics, long-term outcomes, and prognostic factors of perinatal stroke. Methods Patients diagnosed with perinatal stroke were enrolled from 2009-2018. Clinical data including general information, clinical manifestations, and risk factors were collected and compared. Follow-up was performed for at least 2 years. Statistical analysis was performed using the chi-square test, t-tests, and logistic regression analysis. Outcomes Sixty-nine cases were identified with an incidence of 1/2049 live births (51 boys and 18 girls). Twenty-seven patients (39%) experienced perinatal ischemic stroke (PIS) and 42 (61%) perinatal hemorrhagic strokes (PHS). In 48 cases (69%) onset involved acute symptomatic stroke (21 ischemic strokes and 27 hemorrhagic strokes). Seizures within 12-72 h (20 cases, 29%) were the most common presentations. Most (57%) perinatal arterial ischemic strokes focused on the left middle cerebral artery. About 43% of PHS was diagnosed with temporal lobe hemorrhage and 40% of patients exhibited multiple lesions of cerebral parenchymal hemorrhage. There was no association between adverse prognosis after perinatal stroke and different risk factors. During follow-up, six patients (10%) were dead and 22 patients (35%) experienced adverse neurodevelopmental outcomes. Conclusions More infants exhibited hemorrhagic stroke than ischemic stroke. Among infants with asymptomatic perinatal stroke, PHS was more common. The first symptom of perinatal stroke within 12-72 h after birth is convulsions, with the left middle cerebral artery and the temporal lobe the most common lesion sites for ischemic and hemorrhagic strokes, respectively. PIS was more likely to achieve adverse outcomes.