Case report: a case of perinatal ischemic stroke due to arteriovenous malformation

*Correspondence: [e-mail].

Abstract

Case Presentation: We report the case of an ischemic stroke in a newborn. This is a male infant, son of a 37-year-old mother, without comorbidities, with complete prenatal care, no complications during pregnancy and negative serologies. Non consanguineous parents, no family history of epilepsy, first child with traits suggestive of autism. Birth by vaginal delivery, 40 weeks gestation and weight appropriate for gestational age, apgar score 8/9, use of forceps due to maternal exhaustion resulting in tocotrauma and cephalohematoma in the left parietal region. On the second day of life, he presented hypoactivity and spasms in the SLM. A skull X-ray was performed, with no signs of fracture. At this time metabolic causes were also ruled out. Due to the persistence of the condition, he received Phenobarbital - which after a few days was replaced by Levetiracetam. A CT scan of the skull revealed a left parietal fracture with epidural and subgaleal hematoma, leukomalacia, and signs of atrophy in the left frontoparietal subcortical region. Discrete dilatation of the left lateral ventricle and widening of the cortical sulci. The patient evolved with progressive clinical improvement, without new seizures. At 2 months of life, he underwent skull MRI that showed cystic formations in the left parietal region, related to the neurological sequela. In addition, an angioresonance of the skull showed a vascular malformation suggestive of hypoplasia of the middle cerebral artery and its collateral arteries. Thus, we consider that the process that led to the stroke may have started by flow restriction still in the intrauterine period, reducing the chance of a relationship with tocotrauma.

Discussion: Although most neonatal seizures are related to acute brain injury, mainly due to hypoxic-ischemic encephalopathy, about 15% of neonates have neonatal epileptic syndromes, due to congenital brain malformations in 41%, or to genetic etiologies in 42% of this subgroup, with a 9% overlap between structural and genetic etiologies. Neuroimaging, thorough biochemical screening and genetic investigation in the first weeks of life are essential for identification of the underlying etiology, initiation of optimal treatment, and for counseling and prognosis in neonatal epilepsies.

Final Comments: In this context we note the need to rule out structural causes of epilepsies in the neonatal period, their differential diagnoses, and the current prevalence of cases.

Publication History

Article published online:
12 May 2025