Neonatologia
Lo stroke neonatale: le cause, i sintomi, la diagnosi e la gestione
Neonatal stroke: its causes, symptoms, diagnosis and management
Rita Sfeir1,2, Valentina Pelliccia1, Ivana Bruno1, Giulia Graziani1, Paolo Ricciardelli1, Patrizia Cenni3, Giancarlo Piccinini1, Federico Marchetti1
1UOC di Pediatria e Neonatologia, Ospedale di Ravenna, AUSL della Romagna
2Scuola di Specializzazione in Pediatria, Alma Mater Studiorum, Università di Bologna
3UO di Neuroradiologia Diagnostica, Ospedale di Ravenna, AUSL della Romagna
Febbraio 2024 - pagg. 106 -112 | DOI: 10.53126/MEB43106
Abstract
The paper reports the case of a term newborn who presented with focal seizures at 24 hours of age and was diagnosed with neonatal stroke upon the suspicion raised by the cranial ultrasound performed at 24 hours, confirmed by the brain MRI 96 hours past the acute events. Seizures are one of the most common presentations of neonatal stroke; however, they may be subtle and difficult to recognize and may go unnoticed in the newborn. In the neonatal period, especially in the first few days, suspected or confirmed seizures always need to be properly investigated as generally they are secondary to other underlying causes which need to be ruled out (hypoglycaemia, metabolic acidosis, hyperammoniemia, sepsis, etc.). The stroke incidence in the neonatal period is relatively high (1:3,500), including the perinatal, neonatal, presumptive forms and it is crucial to prompt the diagnosis in order to organize a dedicated follow-up involving different specialists and optimize the potential outcome. Recent reviews have confirmed risk factors such as nulliparity and male sex, as well as complex cardiopathy, however literature does not demonstrate the direct causality of events such as operative vaginal delivery and resuscitation at birth.
Riassunto
L'articolo riporta il caso di un neonato a termine che presentava crisi focali a 24 ore dalla nascita e al quale era stato diagnosticato un ictus neonatale su sospetto sollevato dall'ecografia cranica eseguita a 24 ore, confermato dalla risonanza magnetica cerebrale 96 ore dopo gli eventi acuti. Le convulsioni sono una delle manifestazioni più comuni dell'ictus neonatale; tuttavia, possono essere subdoli e difficili da riconoscere e passare inosservati nel neonato. Nel periodo neonatale, soprattutto nei primi giorni, le crisi epilettiche sospette o confermate necessitano sempre di essere adeguatamente indagate in quanto generalmente sono secondarie ad altre cause sottostanti che devono essere escluse (ipoglicemia, acidosi metabolica, iperammoniemia, sepsi ecc.). L'incidenza dell'ictus nel periodo neonatale è relativamente alta (1:3.500), comprese le forme perinatale, neonatale e presunta ed è fondamentale formulare tempestivamente la diagnosi per organizzare un follow-up dedicato che coinvolga diversi specialisti e ottimizzare il potenziale esito. Revisioni recenti hanno confermato fattori di rischio quali nulliparità e sesso maschile, nonché cardiopatie complesse, tuttavia la letteratura non dimostra la causalità diretta di eventi quali parto vaginale operativo e rianimazione alla nascita.
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Corrispondenza: valentina.pelliccia@auslromagna.it