Neonatal Stroke | Diagnosis & Treatment

How is neonatal stroke diagnosed?

Physicians will carefully image your baby's brain to determine the extent of the stroke and which areas of the brain are affected. Procedures used to diagnose stroke include:

  • imaging of the brain and blood vessels in the head and neck using MRI (magnetic resonance imaging), CT (computed tomography) and catheter angiography protocols designed at Boston Children's
  • a cardiology evaluation to look at the heart for possible cardio-embolic causes of stroke
  • blood tests, including a panel of tests associated with bleeding or clotting disorders (thrombophilia testing), inflammatory disorders or metabolic disorders
  • genetic studies to look for hereditary risk factors for blood clots
  • a transcranial ultrasound assessment to assess blood flow in the brain

How is neonatal stroke treated?

When treating an acute neonatal stroke, we quickly assess whether clot-busting (thrombolytic) medicine, such as tissue plasminogen activator (tPA), is appropriate for your child. Previously used only in adults, this treatment can open up blood vessels obstructed by blood clots and limit the stroke's effect on the brain. It must be given within the first 4½ hours after onset of symptoms to be effective.

In some critically ill patients, we may perform endovascular thrombolysis. This treatment involves navigating a very small catheter directly into the area of the clot and delivering clot-dissolving drugs like tPA.

When thrombolytic treatment isn't an option, our goal is to provide the best neuroprotective care possible to limit further damage to the brain. This care focuses on maintaining high blood oxygen levels and optimal blood pressure, to ensure the brain receives the blood flow and oxygen it needs, and controlling blood glucose levels and treating fever, which can exacerbate injury to the brain from stroke.

Long-term care

Regardless of the cause, the problems that result from the stroke (such as weakness and numbness) can sometimes be improved with therapy over time. After the acute period has passed, children are closely followed by our outpatient program, under the care of a child neurologist, hematologist, physiatrist, neuropsychologist and neuroradiologist as well as occupational and physical therapists. We offer weekly clinics to meet our patients' needs and answer any questions. Follow-up neuroimaging and laboratory studies are done as needed and reviewed in advance of the clinic visits.

The stroke team also creates a comprehensive rehabilitation plan for each child to address the long-term consequences of the stroke. This can involve physical, occupational, vision or speech and language therapies or a combination of these. Continuing neurosurgical and neuroradiologic care are also available.