Perinatal Stroke in Two Neonates: Divergent Clinical Presentations From Early Seizures to Incidental Neuroimaging Detection

Perinatal stroke is an important cause of neonatal neurological morbidity and may present with diverse clinical manifestations ranging from seizures to completely asymptomatic cases. Early recognition is challenging because many neonates demonstrate nonspecific or delayed symptoms. We report two neonates diagnosed with perinatal stroke during the first week of life. The first case presented on the third day of life with focal clonic seizures and was found to have a large infarction in the left middle cerebral artery territory with hemorrhagic transformation. The second neonate was admitted with respiratory distress and was later found to have cerebral infarction incidentally during routine cranial ultrasonography. These cases illustrate the variable clinical presentation of perinatal stroke and emphasize the importance of early neuroimaging and multidisciplinary management for accurate diagnosis and long-term neurological follow-up