Yes, a baby can have a stroke while still in the womb. Medical professionals classify this rare but serious event as a fetal stroke. This condition results from a disruption of blood flow to the developing brain, leading to localized injury. Fetal stroke falls under the broader term perinatal stroke, which is a significant cause of neurological impairment in children, affecting an estimated 1 in 1,600 to 1 in 4,000 live births.
Defining Fetal and Perinatal Stroke
Perinatal stroke is an umbrella term for a stroke occurring from the middle of pregnancy until the first 28 days following birth. A stroke happening specifically between the 18th to 20th week of gestation and the onset of labor is designated as a fetal stroke. Strokes diagnosed between birth and 28 days of life are neonatal strokes, while those recognized later in infancy are presumed perinatal strokes.
These strokes are categorized into two main types based on the mechanism of injury. An ischemic stroke, the more common form, occurs when a blood clot blocks an artery, cutting off the supply of oxygen-rich blood to a part of the brain. The most frequent type is perinatal arterial ischemic stroke, accounting for about 70% of symptomatic perinatal cases. The second type is a hemorrhagic stroke, which involves bleeding into the brain tissue, often due to a ruptured blood vessel. Both types result in localized damage that can affect motor, cognitive, and sensory functions.
Primary Causes and Maternal Risk Factors
The causes of fetal stroke are diverse and often complex, with many cases remaining unexplained. Factors affecting the health of the placenta, the organ responsible for nutrient and oxygen exchange, are frequently implicated. Issues like placental abruption (premature separation from the uterine wall) or placental insufficiency (limited blood flow) can starve the fetal brain of necessary oxygen.
Maternal health conditions also contribute to increased risk. Severe preeclampsia, characterized by high blood pressure during pregnancy, can double the likelihood of a perinatal stroke. Inherited or acquired blood clotting disorders (thrombophilias) in the mother may also lead to the formation of clots that can travel to the fetus.
Specific infections that cross the placenta, such as cytomegalovirus (CMV) or toxoplasmosis, are associated with a higher risk of vascular injury. Fetal factors, including congenital heart disease, significantly increase the risk by leading to abnormal blood flow or the formation of clots that travel to the brain.
Other risk factors relate to the process of labor and delivery, particularly those involving fetal distress or mechanical trauma. A difficult or prolonged labor, or the use of assisted delivery techniques like vacuum extraction, can occasionally disrupt blood vessels in the neck or head.
Detection and Diagnosis Before and After Birth
Diagnosing a stroke while the baby is still in the womb is challenging because the fetus does not exhibit overt symptoms. Routine prenatal ultrasound may occasionally detect subtle signs, but specialized imaging like Fetal Magnetic Resonance Imaging (MRI) is generally utilized when suspicion is high or maternal risk factors are known. Fetal MRI provides detailed images of the developing brain, which can sometimes reveal a vascular lesion before birth.
More commonly, the stroke is diagnosed after birth, sometimes immediately or in a delayed fashion later in infancy. Acute signs in a newborn that prompt investigation include focal seizures, which may present as repetitive twitching on one side of the face or body. Other non-specific symptoms are lethargy, poor feeding, or episodes of apnea (where the baby temporarily stops breathing).
The gold standard for confirming a diagnosis of perinatal stroke is a Neonatal MRI, often supplemented with Magnetic Resonance Angiography (MRA) or Venography (MRV). This imaging precisely identifies the location, size, and type of injury, confirming the event as ischemic or hemorrhagic. Blood tests are also performed to screen for underlying conditions, such as inherited clotting disorders or infections, that may have contributed to the stroke.
Long-Term Outcomes and Therapeutic Management
The long-term outcomes following a perinatal stroke are highly variable and depend significantly on the size and location of the brain injury. Approximately 65% of children who experience a perinatal stroke will have some form of permanent neurological disability. The most common long-term consequence is hemiparesis (weakness on one side of the body), which is a form of unilateral cerebral palsy.
Other potential long-term effects include developmental delays, cognitive difficulties, and epilepsy, which may manifest as recurrent seizures. Children often “grow into their deficits,” meaning problems with higher-order functions like attention or executive function may only become apparent as they mature. Early intervention is necessary to maximize recovery and improve the long-term prognosis.
Therapeutic management focuses on harnessing the remarkable plasticity of the infant brain—its ability to reorganize and form new connections to compensate for the damaged area. Early intervention programs are initiated as soon as a diagnosis is confirmed, utilizing a multidisciplinary approach. This approach includes physical therapy (PT), occupational therapy (OT), and speech therapy.
While acute treatments like clot-busting drugs are generally not used in newborns, management centers on supportive care, such as controlling seizures and optimizing overall brain health. The goal of this intensive rehabilitation is to promote alternative pathways in the brain, allowing the child to develop skills and achieve the highest possible quality of life.