Diagnosis of perinatal acute ischemic stroke (AIS) can be subtle and require a high index of suspicion to diagnose.
Keys to the diagnosis:
(1) careful clinical assessment, since findings may be subtle
(2) recognition of risk factors
The onset is often during the first 24 to 72 hours after the delivery.
Clinical features may include:
(1) seizures (common)
(2) apneic episodes
(3) poor feeding
(4) lethargy
(5) general hypotonia
(6) hemiparesis (uncommon)
(7) other focal signs (uncommon)
(8) other subtle findings
Sometimes the diagnosis is not made until later during infancy when the patient shows hemiparesis or developmental delays.
MRI with diffusion-weighted imaging is the most sensitive method of detection during the early stages since it can detect cerebral edema associated with the stroke.
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