Variability in Clinical Presentation of Neonatal Stroke: Report of Four Cases

Figure 1

(a1, a2) Preterm neonate with severe perinatal depression born to mother with no prenatal care: the MRI and MRV images, respectively, show venous sinus thrombosis involving the entire right transverse and sigmoid sinus, most of the straight sinus, and the medial aspect of the left transverse sinus. In this case low molecular weight heparin was initiated. (b1, b2) Term neonate with sepsis, hyperthermia, and suspected episodes of seizures. On T1 images there was an abnormal signal intensity in the lower superior sagittal sinuses as well as bilateral transverse sinuses, consistent with CSVT. A small amount of intraventricular hemorrhage in the posterior body and atrium of the right lateral ventricle was also identified. Infant’s coagulation work-up was negative for any major clotting disorder. (c1, c2) Diffusion weighted images (DWI) as well as ADC Map are shown for a term neonate with no identified risk factors that presented with seizures. (d1, d2) An IUGR infant admitted to the NICU due to suspected apnea and respiratory distress. An MRI without contrast demonstrated a moderately sized acute cortical infarct in the right middle cerebral artery territory, involving the right posterior frontal lobe and frontoparietal junction at the region of the motor strip.