SPECT documents cerebral blood flow, whereas PET with an FDG isotope shows cerebral glucose metabolism. CT scans may not detect an ischemic stroke, especially if it is small, of recent onset, or in the brainstem or cerebellum areas (posterior circulation infarct). MRI is better at detecting a posterior circulation infarct with diffusion-weighted imaging. A CT scan is used more to rule out certain stroke mimics and detect bleeding. The presence of leptomeningeal collateral circulation in the brain is associated with better clinical outcomes after recanalization treatment. Cerebrovascular reserve capacity is another factor that affects stroke outcome – it is the amount of increase in cerebral blood flow after a purposeful stimulation of blood flow by the physician, such as by giving inhaled carbon dioxide or intravenous acetazolamide. The increase in blood flow can be measured by PET scan or transcranial doppler sonography. However, in people with obstruction of the internal carotid artery of one side, the presence of leptomeningeal collateral circulation is associated with reduced cerebral reserve capacity. Underlying cause
When a stroke has been diagnosed, various other studies may be performed to determine the underlying cause. With the current treatment and diagnosis options available, it is of particular importance to determine whether there is a peripheral source of emboli. Test selection may vary since the cause of stroke varies with age, comorbidity and the clinical presentation.
The brachial plexus may be stretched and damaged during a difficult delivery. In minor cases, the nerves heal and full use of the hand and arm is recovered. In more severe cases, the child may sustain permanent nerve damage and may not have full use of the shoulder, arm, or hand. Brachial plexus injuries occur in 1-3 children per 1,000 live births.See Erbs palsy and Klumpkes palsy. Brain damage
Brain damage may be caused by a number of factors, including fetal malformation due to genetic mutation or exposure to toxins, intrauterine hypoxia, or physical trauma during delivery.Cerebral palsy is one example of brain damage incurred before or during delivery; about 10,000 children are diagnosed with cerebral palsy every year. Bruising
A difficult delivery may lead to bruising, especially on the head and face, from pressure against the mothers pelvis or pressure caused by forceps or a vacuum device (see ventouse) used in delivery. Bone fractures
Bone fractures can occur during a difficult delivery. Fracture of the clavicle is the most common birth injury. Meconium aspiration syndrome
Meconium is a sticky substance that usually makes up the childs first bowel movement. If the fetus is stressed before or during delivery, the meconium may be released and may mix with the amniotic fluid. If it gets into the childs airways or lungs, it can cause meconium aspiration syndrome. Serious cases may result in pneumonia or a collapsed lung. Legal issues
Birth injuries may be unavoidable or they may be attributable to medical malpractice.