Hypoxic-ischaemic encephalopathy, perinatal stroke or both? A case report

BackgroundPerinatal stroke is an acute focal brain infarction or haemorrhage occurring from birth to 28 postnatal days. Perinatal stroke typically presents with seizures within 72 h and conversely hypoxic-ischaemic encephalopathy (HIE) presents at birth with signs of encephalopathy.CaseThis case report presents a case of perinatal stroke which was initially treated as HIE. The mother presented in labour and had thick meconium-stained liquor. The patient was born with a poor Apgar score and metabolic acidosis. The patient did not fulfil criteria for cooling therapy, until he developed a focal seizure at 7 h of life. Subsequently, therapeutic hypothermia (TH) therapy was initiated with the diagnosis of neonatal encephalopathy. However, a Magnetic Resonance Imaging (MRI) of the brain performed later showed left posterior cerebral artery territory subacute infarct with haemorrhagic component at the left occipital lobe.ConclusionThe pathophysiology of perinatal stroke is similar to HIE which may lead to similar presentation at birth. Due to the difficulty in differentiating these two diseases, initiating therapeutic hypothermia for HIE is appropriate in this case. Utilisation of scoring tools may aid objective interpretation of MRI findings and prognostication of HIE.