Perinatal Stroke With No Obvious Cause
To the Editor:
In the population-based study from Estonia on the epidemiological characteristics of perinatal stroke,1 the authors analyzed the clinical data of 38 affected patients. Previously identified risk factors for perinatal stroke occurred only in 32% of cases. Neonatal pneumothorax not included into the list of risk factors might result in this serious cerebral event.
We were the first who demonstrated the origin of cerebral arterial air embolization in neonates with pneumothorax.2,3 In the cited article1 58% of the affected newborns had respiratory problems, and 5 were intubated and needed artificial ventilation. Pneumothorax is the most common complication occurring in 30% to 50% of those infants who require mechanical ventilation.4
Moreover, neonatal pneumothorax remains frequently silent, clinically. Because only macroscopic bubbles are identifiable by cranial radiology5 performed in the affected neonates, we may suppose that some of them might have cerebral arterial air embolization leading to stroke, originating from their respiratory complications.
Laugessaar R, Kolk A, Tomberg T, Metsvaht T, Lintrop M, Varendi H, Tavlik T. Acutely and retrospectively diagnosed perinatal stroke: a population–based study. Stroke. 2007; 38: 2234–2240.
Temesvári P, Kovács J, Rácz K. Cerebral arterial air embolism in experimental neonatal pneumothorax. Arch Dis Child. 1989, 64: 178.
Textbook of Neonatology. Roberton NRC, ed. London: Churchill Livingstone; 1992: 450.
Menéndez-González M, Oliva-Nacarino P, Alvarez-Cofino A. Cerebral gas embolism caused by pleural fibrinolytic treatment. Stroke. 2007, 38: 2602–2604.