Outcome and epilepsy following neonatal stroke in the Italian Registry of Infantile Thrombosis

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The perinatal period is a high-risk time for stroke, with possible lifelong effects. We aimed at identifying factors associated with long-term neurological outcomes and post-stroke epilepsy in patients with neonatal arterial ischemic stroke (NAIS). We analyzed patients with NAIS from the Italian Registry of Infantile Thrombosis (RITI). Associations between clinical variables and outcomes (neurological deficits and epilepsy at last follow-up) were evaluated using univariate logistic regression. Among the 181 patients included (56.2% male), seizures were the most common initial symptom (79.4%). Stroke was left-sided in 62.0%, and bilateral in 15.0%; multiple lesions were reported in 32.5%. The middle cerebral artery territory was most frequently involved. One patient had a new infarction during hospitalization, and one died. At follow-up (median 21 months), no further recurrences or deaths occurred; neurological deficits were reported in 38.8%, and post-stroke epilepsy in 12.0% (among these latter, prior acute seizures occurred in 86.7%). At univariate regression, factors significantly associated with long-term neurological deficits were higher maternal age (p = 0.031); urgent cesarean (p < 0.001); lower gestational age (p = 0.033); neurological deficits at discharge (p < 0.001); seizures at last follow-up (p = 0.008). Factors significantly associated with post-stroke epilepsy were need for acute-phase assisted ventilation (p = 0.001); radiological brainstem involvement (p = 0.037); and longer admission duration (p = 0.050). CONCLUSION: Mortality and recurrence after NAIS are rare, but neurological deficits occur in about 40%, and epilepsy in 12%. Perinatal and clinical factors may predict adverse outcomes and epilepsy. WHAT IS KNOWN: • The perinatal period is a high-risk window for neonatal arterial ischemic stroke (NAIS), with seizures as the most common presenting symptom. Mortality and recurrent strokes after NAIS are rare, but long-term neurological deficits and post-stroke epilepsy are recognized complications. WHAT IS NEW: • In this registry-based cohort, specific perinatal and clinical factors-such as higher maternal age, urgent cesarean delivery, lower gestational age, neurological deficits at discharge, and seizures at follow-up-were significantly associated with long-term neurological impairments. • Risk factors for post-stroke epilepsy were identified, including need for acute-phase assisted ventilation, radiological brainstem involvement, and longer hospital stays, providing new insights for early prognostication and follow-up strategies.

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