Perinatal stroke can occur during pregnancy or delivery. Treatment for a stroke in a fetus or newborn differs from adults and does not typically involve blood thinners.

People of any age can experience a stroke, including infants and children. Sometimes, a stroke may occur during the fetal stage before birth.

Perinatal stroke is a traumatic brain injury involving the blood vessels that occurs from the fetal period up to 28 days after birth. This type of stroke usually occurs between the middle of pregnancy and delivery and may affect about 1 in 3,500 live births.

This article looks at the warning signs and symptoms, causes, risk factors, treatment, outlook, and diagnosis of perinatal stroke. It also looks at life after a perinatal stroke and outlines resources for caregivers.

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Signs and symptoms of stroke may differ between different age groups.

Newborns and what to do

The most common signs of perinatal stroke in newborns include:

  • seizures, which can show up as repetitive twitching in the arms, face, or legs
  • lethargy
  • apnea, which may show up as pauses in breathing and staring
  • poor feeding

If a person notices signs of stroke in a newborn, they should immediately contact emergency medical services.

Prompt treatment may result in a better outcome and can help minimize damage to the brain.

Developing babies and what to do

Signs a developing baby may have suffered a stroke include:

  • weakness or a decrease in movement on one side of the body
  • favoring the use of one particular hand before 12 months of age
  • delays in development

If a person notices signs of a stroke in a developing baby, they should seek immediate medical attention.

Learn more about strokes.

Most of the time with perinatal stroke, the cause is not obvious.

Factors that may increase the risk of perinatal stroke include:

Maternal risk factors may include:

Treatment for perinatal stroke involves treating seizures, dehydration, and anemia and providing oxygen therapy.

While doctors may treat older children who have had a stroke with blood thinning medications, such as aspirin, doctors do not typically treat neonatal infants in this way unless there is a high risk of recurring stroke.

There is no evidence for the use of clot-dissolving drugs, known as thrombolytics, in neonatal infants.

Additionally, the small size of the arteries in a fetus or infant means doctors cannot perform procedures, such as a mechanical thrombectomy.

Most neonatal infants who have a perinatal stroke go on to experience residual neurological effects.

A study of 111 children with perinatal stroke found that 68% developed cerebral palsy, and nearly 75% of these children also had at least one other disability. Additionally, 47% of the children had epilepsy, and 59% had speech or cognitive impairment.

The likelihood of another stroke is low after an initial perinatal stroke, except in neonatal infants with congenital heart disease.

Potential complications that may follow perinatal stroke include:

  • cerebral palsy, a condition that makes it difficult for someone to move certain parts of their body
  • epilepsy
  • learning and cognitive difficulties
  • memory problems
  • speech and language difficulties
  • visual impairments
  • changes in behavior
  • weakness on one side of the body

To diagnose perinatal stroke, doctors typically perform brain imaging scans, such as:

  • Magnetic resonance imaging (MRI): An MRI scan uses radio waves, a large magnet, and a computer to produce detailed brain images.
  • Magnetic resonance angiography (MRA): Doctors may use an MRA scan to examine the blood vessels.
  • Magnetic resonance venography (MRV): Doctors may use an MRV scan to closely examine veins.

After a perinatal stroke, a child may experience long-term effects that can affect their development, movement, ability to think, and emotional well-being.

In the months and years after the stroke, the following types of therapy may help improve a child’s abilities and quality of life:

  • Speech therapy can help with communication and speech and language development, swallowing and eating abilities, and suck-swallow coordination.
  • Physical therapy can help improve motor skills, muscle tone and function, movement abilities, and balance.
  • Occupational therapy can help improve fine motor skills and help children learn and play.

The following organizations and services can offer support to struggling parents and caregivers:

Perinatal stroke most commonly occurs between the middle of pregnancy and delivery.

Possible risk factors for perinatal stroke include congenital heart disease, infections, placenta disorders, preeclampsia, and vacuum extraction during delivery.

Doctors usually diagnose perinatal stroke using imaging, such as an MRI scan. Treatment typically focuses on supportive care.

Most people who experience perinatal stroke develop long-term effects, such as cerebral palsy, epilepsy, and cognitive dysfunction.

Rehabilitation therapies, such as speech, physical, and occupational therapy, may improve a child’s abilities and well-being.