Summary The few days before and after birth are a time of special risk for stroke in both mother and infant, probably related to activation of coagulation mechanisms in this critical period. Arterial ischaemic stroke around the time of birth is recognised in about one in 4000 full-term infants, and may present with neurological and systemic signs in the newborn. Neonatal seizures are most commonly the clinical finding that triggers assessment. In other children, perinatal stroke is recognised only retrospectively, with emerging hemiparesis or seizures after the early months of life. Risk factors for perinatal stroke include hereditary or acquired thrombophilias and environmental factors. Perinatal stroke underlies an important share of congenital hemiplegic cerebral palsy, and probably some spastic quadriplegic cerebral palsy and seizure disorders. There is much to be learned about the natural history of perinatal stroke, and there are as yet no evidence-based strategies for prevention or treatment.

https://zenodo.org/record/1260258/files/article.pdf

Stroke in newborn infants

THE effect of cocaine use by pregnant women on their fetuses and then newborn infants is a topic of major public health importance. Cocaine has profound effects on the central and peripheral nervous systems of adults and can cause major alterations in fetal brain structure and subsequently in neurologic, cognitive, and behavioral functions. From 10 to 45 percent of women cared for at urban teaching hospitals take cocaine during their pregnancies, considerably more than did so 10 to 15 years ago.1 2 3 4 5 6 7 8 9 10 The problem of fetal exposure to cocaine is not confined to urban hospital populations; in a recent study 6 . . .

Effect of Cocaine Use on the Fetus

Mean visual acuity.

Perinatal stroke has become increasingly recognized, but the incidence is probably underestimated because of variation in the presentation, evaluation, and diagnosis. Based on estimates from population-based studies of infants with seizures, perinatal stroke occurs in approximately 1 in 4000 term births. Most perinatal strokes involve the middle cerebral artery and are caused by thromboembolism from an intracranial or extracranial vessel, the heart, or the placenta. Cardiac disorders, coagulation abnormalities, and infection are risk factors for stroke in the perinatal period. This article discusses the epidemiology of ischemic stroke occurring in the perinatal and neonatal period, including cerebrovascular events that are diagnosed during the perinatal period and those diagnosed retrospectively, when evidence of hemiparesis or postneonatal seizures leads to later evaluation and neuroimaging.

Epidemiology of perinatal stroke.

Developmental disorders

• We describe 10 infants with developmental delay and congenital cerebral anomalies who were found to have had in utero exposure to vasoactive drugs. Nine infants had ophthalmological abnormalities; these included strabismus, nystagmus, and/or hypoplastic optic discs. Six mothers used cocaine, one used cocaine and heroin, one used only heroin, one used amphetamine, and one used phenylpropanolamine. Each of these cerebral anomalies (agenesis of the corpus callosum, septo-optic dysplasia, schizencephaly, hydranencephaly, congenital hydrocephalus, porencephaly, and cerebral infarctions) can be attributed to insults at different stages of development. There appears to be a relationship between the time of prenatal drug exposure and the type of cerebral anomaly, evoking malformations, disruptions, or fetal strokes. Since many or possibly all of these anomalies are thought to have a vascular origin, it seems appropriate to implicate prenatal exposure to vasoactive drugs. ( AJDC . 1991;145:688-695)

Brain and Ocular Abnormalities in Infants With In Utero Exposure to Cocaine and Other Street Drugs

Congenital idiopathic microcoria.

Lacrimal anomalies in Brachmann-de Lange's syndrome.

• Microdissection of the muscular vessels allows recessions, resections, or transpositions of the recti muscles without interrupting the blood flow to the corresponding anterior ciliary arteries. This avoids postoperative impaired blood flow to the anterior segment and may play a role in preventing anterior segment ischemia syndrome. The use of a fine-hooked cannula and microscissors, in addition to the usual strabismus surgery instruments, is described.

Vascular Microdissection in Strabismus Surgery

A new technique to obtain patency of the lacrimal drainage system was used in three children with bilateral congenital obstruction of the lacrimonasal duct (six cases) and upper canalicular abnormalities (five cases). The upper canalicular abnormalities prevented bicanaliculonasal intubation.A silicone tube was passed through the lower canaliculus, traversing the lacrimal drainage system and into the nasal fossa. The proximal end of the tube was placed subconjunctival in the inferior fornix and secured. The distal end of the tube was passed through the subcartilaginous nasal septum to the contralateral nasal fossa and tied to a tube similarly passed through the opposite lacrimal system.The procedure was successful in all six cases, with all tubes remaining in place the desired length of time. Postoperative identification and removal of the tubes offered no difficulties and was followed by permanent patency of the lacrimal drainage system in all six cases.

Antonio Aguirre Vila-Coro

Papers

Brain and Ocular Abnormalities in Infants With In Utero Exposure to Cocaine and Other Street Drugs

Congenital idiopathic microcoria.

Lacrimal anomalies in Brachmann-de Lange's syndrome.

Vascular Microdissection in Strabismus Surgery

Monocanalicular lacrimonasal intubation.