Spontaneous cerebral infarction in a full - term neonate

Background. Cerebral vascular accident (CVA) is an important cause of hemorrhagic or ischemic cerebral injury and increases neonatal morbidity and mortality. It occurs in 1/4000 term neonates. We report a case of a neonate with a spontaneous CVA. Case report. We present the case of a newborn (NB) who was delivered from a 31-year old mother. It was the second pregnancy with 41.5 weeks of gestation. The mother presented gestational diabetes controlled only by dietary therapy. A 3640-g, apparently healthy female was obtained by cesarean delivery that was indicated due to cephalopelvic disproportion. Apgar scores were 8-9 according to the conventional time points. The pediatrician used only initial steps of reanimation. During the first day of life, the infant presented a deviation of the right mouth commissure and tonic-clonic movements on the right half of the body two times. The newborn was treated with phenobarbital intravenous infusion. Laboratory tests were all normal, and cultures of cerebrospinal fluid and blood were considered negative. A head sonogram showed no evidence of hemorrhage or ventricular distortion but a cranial CT reported a low-density zone suggesting a cerebral infarction in the left parietal and temporal regions. Conclusions. We continued to treat with phenobarbital and acetylsalicylic acid and the patient remained asymptomatic prior to discharge at the 7th day of life, recommending follow-up with a pediatric neurologist.