Skip to main content
SpringerLink
Log in

Perinatal Stroke as an Etiology of Cerebral Palsy

  • Reference work entry
  • First Online:
Cerebral Palsy

  • 143 Accesses

Abstract

Cerebral palsy is a group of heterogeneous disorders with a broad range of developmental outcomes and a spectrum of neurologic impairment. In the past, several studies had suggested thrombophilia as an etiology for perinatal stroke. However, as new evidence accumulates, we know that perinatal stroke is due to multifactorial etiologies. Multiple fetal and maternal risk factors can contribute to a thrombophilic microenvironment: infections, trauma, cardiac disorders, blood disorders, and placental disorders. Thus, the evaluation of a pediatric patient with perinatal stroke should include a comprehensive workup assessing the mother, infant, and, if possible, the placenta. Currently, there is no strong evidence for treatment with antiplatelet or antithrombotic agents for patients with perinatal stroke except for those with a cardiac comorbidity or venous sinus thrombosis. The overall treatment is largely supportive care. The focus of preventative care is on improving the quality of life for the pregnant mother as well as the child and maintaining a heart-healthy lifestyle to prevent secondary cardiac etiologies. Future research is needed to further evaluate possible etiologies, such as maternal risk factors, environmental risk factors, and fetal risk factors, as they relate to the timing of insult to the developing fetus.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Arendt RE, Minnes S, Singer LT (2013) Fetal cocaine exposure: neurologic effects and sensory-motor delays. Pediatr Neurol 49(1):8–14

    Article  Google Scholar 

  • Basu AP (2014) Early intervention after perinatal stroke: opportunities and challenges. Dev Med Child Neurol 56(6):516–521

    Article  Google Scholar 

  • Bernson-Leung M, Boyd T, Danehy A et al (2015) Placental pathology in neonatal stroke: a retrospective case-control study. Neurology 86((16) Supplement):S42.006

    Google Scholar 

  • Bruno CJ, Beslow LA, Witmer CM et al (2014) Hemorrhagic stroke in term and late preterm neonates. Arch Dis Child Neonatal Ed 99(1):48–53

    Article  Google Scholar 

  • Cattaneo M, Tsai MY, Bucciarelli P et al (1997) A common mutation in the methylenetetrahydrofolate reductase gene (C677T) increases the risk for deep-vein thrombosis in patients with mutant factor V (factor V:Q506). Arterioscler Thromb Vasc Biol 17(9):1662–1666

    Article  CAS  Google Scholar 

  • Chen C-Y, Tafone S, Lo W, Heathcock JC (2015) Perinatal stroke causes abnormal trajectory and laterality in reaching during early infancy. Res Dev Disabil 38:301–308

    Article  CAS  Google Scholar 

  • Curry CJ, Bhullar BS, Holmes J et al (2007) Risk factors for perinatal arterial stroke: a study of 60 mother-child pairs. Pediatr Neurol 37(2):99–107

    Article  Google Scholar 

  • Curtis C, Mineyko A, Massicotte P et al (2017) Thrombophilia risk is not increased in children after perinatal stroke. Blood 129(20):2793–2800

    Article  CAS  Google Scholar 

  • deVeber GA, Kirton A, Booth FA et al (2017) Epidemiology and outcomes of arterial ischemic stroke in children: the Canadian pediatric ischemic stroke registry. Pediatr Neurol 69:58–70

    Article  Google Scholar 

  • Elbers J, Viero S, MacGregor D, DeVeber G, Moore AM (2011) Placental pathology in neonatal stroke. Pediatrics 127(3):e722–e729

    Article  Google Scholar 

  • Fernandez-Lopez D, Natarajan N, Ashwal S et al (2014) Mechanisms of perinatal arterial ischemic stroke. J Cereb Blood Flow Metab 34:921–932

    Article  CAS  Google Scholar 

  • Gibson CS, MacLennan AH, Goldwater PN et al (2003) Antenatal causes of cerebral palsy: associations between inherited Thrombophilias, viral and bacterial infection, and inherited susceptibility to infection. Obstet Gynecol Surv 58(3):209–220

    Google Scholar 

  • Golomb MR, MacGregor DL, Domi T et al (2001) Presumed pre- or perinatal arterial ischemic stroke: risk factors and outcomes. Ann Neurol 50:163–168

    Article  CAS  Google Scholar 

  • Harbert MJ, Tam EWY, Glass HC et al (2011) Hypothermia is correlated with seizure absence in perinatal stroke. J Child Neurol 26(9):1126–1130

    Article  Google Scholar 

  • Kasdorf E, Perlman JM (2013) Hyperthermia, inflammation, and perinatal brain injury. Pediatr Neurol 49(1):8–14

    Google Scholar 

  • Kirton A, deVeber G (2006) Cerebral palsy secondary to perinatal ischemic stroke. Clin Perinatol 33:367–386

    Article  Google Scholar 

  • Kirton A, deVeber G (2009) Advances in perinatal ischemic stroke. Pediatr Neurol 40(3):205–214

    Article  Google Scholar 

  • Kirton A, deVeber G, Pontigon A-M et al (2008) Presumed perinatal ischemic stroke: vascular classification predicts outcomes. Ann Neurol 63:436–443

    Article  Google Scholar 

  • Kitai Y, Haginoya K, Hirai S et al (2016) Outcome of hemiplegic cerebral palsy born at term depends on its etiology. Brain Dev 38:267–273

    Article  Google Scholar 

  • Kuczynski A, Dukelow S, Semrau J et al (2016) Robotic quantification of position sense in children with perinatal stroke. Neurorehabil Neural Repair 30(8):762–772

    Article  Google Scholar 

  • Kurnik K, Kosch A, Strater R et al (2003) Recurrent thromboembolism in infants and children suffering from symptomatic neonatal arterial stroke. Stroke 34:2887–2893

    Article  Google Scholar 

  • Lehman L, Rivkin M (2014) Perinatal arterial ischemic stroke: presentation, risk factors, evaluation, and outcome. Pediatr Neurol 51:760–768

    Article  Google Scholar 

  • Lynch J (2009) Epidemiology and classification of perinatal stroke. Semin Fetal Neonatal Med 14:245–249

    Article  Google Scholar 

  • Lynch JK, Hirtz DG, DeVeber G et al (2002) Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke. Pediatrics 109(1):116–123

    Article  Google Scholar 

  • Monagle P, Chalmers E, Chan A et al (2008) Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:887S–968S

    Article  CAS  Google Scholar 

  • Nelson KB (2006) Thrombophilias, perinatal stroke, and cerebral palsy. Clin Obstet Gynecol 49(4):875–884

    Article  Google Scholar 

  • Nelson KB (2007) Perinatal ischemic stroke. Stroke 38(part 2):742–745

    Article  Google Scholar 

  • Nelson KB, Dambrosia JM, Grether JK, Phillips TM (1998) Neonatal cytokines and coagulation factors in children with cerebral palsy. Ann Neurol 44(4): 665–675

    Article  CAS  Google Scholar 

  • Pavlakis SG, Levinson K (2009) Arterial ischemic stroke: common risk factors in newborns and children. Stroke 40:S79–S81

    Article  Google Scholar 

  • Peixoto MV, de Carvalho JF, Rodrigues CE (2014) Clinical, laboratory, and therapeutic analyses of 21 patients with neonatal thrombosis and antiphospholipid antibodies: a literature review. J Immunol Res 2014:672603

    Article  Google Scholar 

  • Reid D, Halliday J, Ditchfield M et al (2006) Factor V Leiden mutation: a contributory factor for cerebral palsy? Dev Med Child Neurol 48:14–19

    Google Scholar 

  • Rouse DJ, Hirtz DG, Thom E et al (2008) A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 359:895–905

    Article  CAS  Google Scholar 

  • Thorarensen O, Ryan S, Hunter J et al (1997) Factor V Leiden mutation: an unrecognized cause of hemiplegic cerebral palsy, neonatal stroke, and placental thrombosis. Ann Neurol 42(3):372–375

    Article  CAS  Google Scholar 

  • Varga EA, Moll S (2004) Prothrombin 20210 mutation (Factor II mutation). Circulation 110:x15–e18

    Article  Google Scholar 

  • Wolberg AS, Aleman MM, Leiderman K, Machlus KR (2012) Procoagulant activity in hemostasis and thrombosis: Virchow’s triad revisited. Anesth Analg 114(2):275–285

    Article  CAS  Google Scholar 

  • Wu YW, Lynch JK, Nelson KB (2005) Perinatal arterial stroke: understanding mechanisms and outcomes. Semin Neurol 25(4):424–434

    Article  Google Scholar 

  • Xu H, Cao Y, Yang X et al (2017) ADAMTS13 controls vascular remodeling by modifying VWF reactivity during stroke recovery. Blood 130(1):11–22

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Nidhi Shah & Gregory C. Griffin

Authors
  1. Nidhi Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregory C. Griffin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nidhi Shah .

Editor information

Editors and Affiliations

  1. Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Freeman Miller

  2. Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, USA

    Steven Bachrach

  3. Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Nancy Lennon

  4. Columbia University, Irving Medical Center, Programs in Physical Therapy, New York, NY, USA

    Margaret E. O'Neil

Section Editor information

  1. Department of Pediatrics (Emeritus), Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Steven J. Bachrach

  2. Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA

    Steven J. Bachrach

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Shah, N., Griffin, G.C. (2020). Perinatal Stroke as an Etiology of Cerebral Palsy. In: Miller, F., Bachrach, S., Lennon, N., O'Neil, M.E. (eds) Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-319-74558-9_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74558-9_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74557-2

  • Online ISBN: 978-3-319-74558-9

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation