[Cerebrovascular accidents in full-term newborn infants].

INTRODUCTION: The purpose of this paper is to review the role of the neurologist in the management of cerebrovascular accidents (CVA) (insults resulting from a sudden obstruction or rupture of an intracranial vessel). This was accomplished by reviewing the literature (PubMed) under the heading of stroke and term neonate.

DEVELOPMENT: CVA in full-term neonates are classified as hematomas and infarcts. Hematomas are classified according to: location, structure (arterial, venous, or sinus), type of malformation (aneurysm, venous malformation, and telangiectasia), and cause of the bleed (vessel wall rupture or hypo-coagulation). Classification according to location is based on compartment supra or infratentorial; space -extra-axial (epidural, subdural, or subarachnoid) or intra-axial (parenchymal or ventricular)-; and region -parietal, temporal, thalamic, etc.-. Infarcts are classified according to vascular and parenchymal factors. The vascular factors are the structure, the cause of the obstruction -extramural, mural or intramural (thrombus or embolus)-. The parenchymal factors are type of damage (pale vs hemorrhagic) and location. Patients with suspected embolism should have ultrasound neck. Coagulation studies should be done in patients with hematomas and infracts. Multiple causes may be present in each case. Anticoagulation is only used in small pale infarcts of cardiac embolic origin.

CONCLUSION: The neurologist roles in the management of CVA are to classify the event, select the appropriate investigation, and implement treatment.