Lo stroke neonatale: le cause, i sintomi, la diagnosi e la gestione

The paper reports the case of a term newborn who presented with focal seizures at 24 hours of age and was diagnosed with neonatal stroke upon the suspicion raised by the cranial ultrasound performed at 24 hours, confirmed by the brain MRI 96 hours past the acute events. Seizures are one of the most common presentations of neonatal stroke; however, they may be subtle and difficult to recognize and may go unnoticed in the newborn. In the neonatal period, especially in the first few days, suspected or confirmed seizures always need to be properly investigated as generally they are secondary to other underlying causes which need to be ruled out (hypoglycaemia, metabolic acidosis, hyperammoniemia, sepsis, etc.). The stroke incidence in the neonatal period is relatively high (1:3,500), including the perinatal, neonatal, presumptive forms and it is crucial to prompt the diagnosis in order to organize a dedicated follow-up involving different specialists and optimize the potential outcome. Recent reviews have confirmed risk factors such as nulliparity and male sex, as well as complex cardiopathy, however literature does not demonstrate the direct causality of events such as operative vaginal delivery and resuscitation at birth.