Click to Schedule Your FREE Consultation Today Schedule Now

August 25, 2026

Perinatal Stroke and Seizures in Kentucky Newborns

Morrin Law Office
C

A seizure in a newborn can be subtle.

Instead of the dramatic whole-body convulsions many people associate with epilepsy, a neonatal seizure may involve repeated movement of one arm or leg, unusual eye or mouth movements, changes in breathing, or electrical seizure activity that is difficult or impossible to recognize simply by watching the baby.

One important cause of neonatal seizures is perinatal stroke.

Stroke can occur before birth, during delivery, or during the newborn period. Some strokes are diagnosed almost immediately because the baby develops seizures or other neurological symptoms. Others are not recognized until months later, when parents notice an early hand preference, weakness on one side, delayed motor development, or another neurological difference.

Neither a perinatal stroke nor a neonatal seizure automatically means that a doctor, nurse, or hospital committed malpractice.

For a Kentucky birth injury investigation, important questions can include:

  • When did the neurological symptoms begin?
  • What did the symptoms look like?
  • Was continuous EEG monitoring appropriate?
  • When was EEG started?
  • When was brain imaging obtained?
  • What did the MRI show?
  • Was the event an arterial stroke, venous thrombosis, hemorrhage, HIE, infection, or another condition?
  • Were seizures treated appropriately?
  • Did a delay in diagnosis or treatment actually cause additional injury?
  • Does the medical evidence support a preventable departure from appropriate care?

This guide explains those issues, current neonatal seizure guidance, records to preserve, Kentucky treatment resources, and Kentucky legal rules that may apply.

What Is Perinatal Stroke?

A stroke occurs when normal blood flow in the brain is disrupted or bleeding occurs within or around the brain.

The American Heart Association and American Stroke Association broadly classify stroke occurring in late pregnancy through the first 28 days after birth as perinatal stroke.

Several different conditions can fall under that umbrella.

Perinatal Arterial Ischemic Stroke

An arterial ischemic stroke occurs when an artery supplying part of the brain becomes blocked, reducing blood and oxygen delivery to brain tissue.

Arterial ischemic injury accounts for most perinatal strokes described in AHA/ASA materials.

Cerebral Sinovenous Thrombosis

Cerebral sinovenous thrombosis, sometimes abbreviated CSVT or CVST, occurs when a clot forms in one of the veins or venous sinuses responsible for draining blood from the brain.

The evaluation and treatment of venous thrombosis can differ from arterial stroke.

Hemorrhagic Stroke

A hemorrhagic stroke occurs when bleeding damages brain tissue.

Potential forms can involve bleeding within the brain or other intracranial bleeding patterns.

The type, location, size, and cause of the stroke all influence treatment and prognosis.

How Common Is Stroke in Newborns?

Stroke is uncommon in childhood overall, but newborns have one of the highest stroke risks within the pediatric population.

The AHA/ASA scientific statement on stroke in neonates and children cites a newborn stroke risk of approximately 1 in 4,000 live births.

Estimates vary depending on:

  • Which stroke types are counted
  • Whether only symptomatic neonatal strokes are included
  • Whether children diagnosed months later are included
  • The population being studied

Because some perinatal strokes are not recognized during the newborn period, exact incidence can be difficult to measure.

Neonatal Stroke vs. Presumed Perinatal Stroke

The timing of diagnosis matters.

Neonatal Stroke

A neonatal stroke is recognized during the newborn period.

A common presentation is a focal seizure, such as repeated movement affecting one side of the body.

Presumed Perinatal Stroke

Sometimes a stroke occurred around birth but was not recognized then.

The child may appear relatively well as a newborn and later develop:

  • Early preference for one hand
  • Weakness affecting one side
  • Asymmetric crawling or movement
  • Delayed motor milestones
  • Spasticity
  • Seizures
  • Developmental concerns

Imaging obtained later may then show an older brain infarction consistent with a perinatal event.

This is often described as a presumed perinatal stroke.

An early hand preference is therefore generally a later clue, not a typical sign observed in the first hours after birth.

What Causes Perinatal Stroke?

There is no single cause.

Potential associations and risk factors can include:

  • Placental problems
  • Blood-clotting abnormalities
  • Congenital heart disease
  • Infection
  • Inflammation
  • Dehydration
  • Maternal or fetal conditions affecting coagulation
  • Birth complications
  • Cerebral venous thrombosis
  • Vascular abnormalities
  • Other perinatal conditions

In many newborns, no single definitive cause is identified.

That is important legally.

The fact that a baby experienced a stroke does not establish that something during labor or delivery caused it.

What Are the Signs of Stroke in a Newborn?

The AHA/ASA identifies seizures as a particularly important presentation of neonatal arterial ischemic stroke.

Potential findings can include:

  • Focal seizures involving one arm or leg
  • Repetitive abnormal movement
  • Changes in muscle tone
  • Encephalopathy
  • Abnormal alertness
  • Poor feeding
  • Apnea or unusual breathing episodes
  • Other neurological abnormalities

Not every newborn with one of these symptoms has suffered a stroke.

Other possibilities include:

  • HIE
  • Infection
  • Metabolic disturbance
  • Low blood glucose
  • Intracranial hemorrhage
  • Genetic epilepsy
  • Brain malformation
  • Medication effects
  • Other neurological conditions

That is why neurological testing matters.

What Are Neonatal Seizures?

A neonatal seizure is abnormal electrical activity in a newborn’s brain.

Neonatal seizures differ from seizures in older children and adults.

Some have a visible clinical manifestation.

Others are detectable only on EEG.

What Can a Newborn Seizure Look Like?

Possible clinical signs can include:

  • Rhythmic jerking of one arm or leg
  • Repetitive facial movement
  • Eye deviation
  • Repeated mouth or tongue movements
  • Abnormal stiffening
  • Sudden changes in tone
  • Apnea associated with other neurological findings
  • Repeated unusual movements

But newborn movements can also mimic seizures.

Normal or non-epileptic behaviors can include:

  • Jitteriness
  • Tremor
  • Startle
  • Sleep movements
  • Certain repetitive movements

Observation alone may therefore be unreliable.

Can a Newborn Have a Seizure With No Visible Movement?

Yes.

Some neonatal seizures are electrographic-only, meaning abnormal seizure activity occurs on EEG without a clear clinical sign visible to parents or bedside staff.

That is one reason continuous EEG monitoring has become so important in neonatal neurological care.

It also explains why a child’s chart may document a seizure burden greater than what anyone observed visually.

Why Continuous EEG Matters

The American Clinical Neurophysiology Society issued a new guideline in January 2025 addressing continuous EEG monitoring in newborns.

The guideline conditionally recommends continuous EEG, or cEEG, in several important situations.

When Seizures Are Clinically Suspected

ACNS suggests cEEG to improve the accuracy of seizure diagnosis when a newborn has events suspected to be seizures.

The guideline specifically compares cEEG favorably with relying only on:

  • Clinical observation
  • Amplitude-integrated EEG alone
  • A short routine or “spot” EEG

That does not mean every unusual newborn movement automatically requires prolonged EEG.

The indication depends on the clinical circumstances and whether monitoring is likely to affect medical decisions.

When a Newborn Is at High Risk for Seizures

ACNS also suggests cEEG monitoring for certain newborns at high risk for seizures even when obvious seizures have not been seen.

Clinical groups with evidence supporting screening include newborns with conditions such as:

  • Acute ischemic stroke
  • HIE
  • Intracranial hemorrhage
  • Encephalopathy
  • Intracranial infection
  • Certain extremely premature infants
  • Some metabolic disorders

The strength of the evidence varies among conditions.

The guideline’s recommendations are conditional rather than universal mandates for every infant.

After a Seizure Has Been Diagnosed

ACNS also suggests cEEG for newborns with definite seizures to determine whether treatment is actually controlling seizure activity.

That matters because a baby’s visible movements may stop while electrographic seizures continue.

Conversely, abnormal-looking movements may persist even though they are no longer seizures.

cEEG vs. aEEG vs. a Routine EEG

These terms are often confused.

Continuous EEG

Continuous EEG, or cEEG, records electrical activity from multiple scalp electrodes over an extended period.

When combined with video, clinicians can compare movements with the underlying EEG.

It is the most detailed of these commonly used neonatal seizure-monitoring approaches.

Amplitude-Integrated EEG

Amplitude-integrated EEG, or aEEG, uses a simplified display of brain activity.

It can be useful for bedside neuromonitoring and seizure screening.

However, it provides less detailed information than full conventional EEG.

The 2025 ACNS guideline suggests confirming suspected aEEG seizure events with cEEG.

Routine or Spot EEG

A routine EEG records brain activity during a shorter examination.

It can be useful in some circumstances, but a brief recording may miss intermittent seizures.

The appropriate form and duration of EEG monitoring depend on the baby’s condition and available resources.

How Is a Perinatal Stroke Diagnosed?

MRI

For suspected neonatal arterial ischemic stroke, the AHA/ASA identifies brain MRI as an important diagnostic study.

MRI can help show:

  • Whether a stroke occurred
  • Which region of the brain is affected
  • Approximate extent of injury
  • Other possible diagnoses

MRA and MRV

Additional vascular imaging may include:

  • MRA, or magnetic resonance angiography, to evaluate arteries
  • MRV, or magnetic resonance venography, to evaluate cerebral veins and venous sinuses

MRV can be especially important when cerebral sinovenous thrombosis is suspected.

Ultrasound

Cranial ultrasound is commonly used in newborn care and may identify certain hemorrhages or other abnormalities.

However, whether ultrasound is adequate for a suspected stroke depends on the clinical situation.

MRI generally provides more detailed assessment of many neonatal brain injuries.

CT

CT may be used in selected circumstances, particularly when an urgent assessment of bleeding is necessary or MRI is not immediately feasible.

The imaging decision belongs to the treating medical team.

When Might a Stroke or Seizure Case Raise Questions About Medical Negligence?

The diagnosis alone is not enough.

Potential issues depend heavily on what happened and whether an alleged delay changed the outcome.

Failure to Evaluate Repeated Focal Seizure-Like Events

Focal seizures are a recognized presentation of neonatal arterial ischemic stroke.

A potential case may examine:

  • What movements were observed
  • When they began
  • How often they occurred
  • Whether staff documented them
  • Whether neonatal or neurological consultation was obtained
  • Whether EEG was considered
  • Whether imaging was performed

The analysis must also recognize that many newborn behaviors can resemble seizures.

The legal question is not simply whether the eventual diagnosis was initially missed, but whether the evaluation was reasonable based on the information available.

Delay in Continuous EEG Monitoring

A possible investigation may examine whether a newborn with a clinically suspected seizure or a recognized high-risk neurological condition should have undergone cEEG.

Relevant questions may include:

  • When seizure concern arose
  • What symptoms were documented
  • Whether cEEG was available
  • Whether a neurologist was consulted
  • When monitoring began
  • Whether only a brief EEG was performed
  • What the EEG ultimately showed

The 2025 ACNS guideline should not be treated as a universal rule requiring cEEG for every newborn with an unusual movement.

Its recommendations are conditional and acknowledge resource and feasibility considerations.

Failure to Recognize Electrographic Seizures

Once cEEG is underway, records may show seizures that were not obvious clinically.

Potential questions can include:

  • How quickly the study was interpreted
  • When a seizure was identified
  • When the treatment team was notified
  • Whether treatment was ordered
  • Whether continued EEG showed persistent seizures

Delay in Brain Imaging

A baby with confirmed seizures and other neurological abnormalities may need imaging to identify the underlying cause.

A medical review may examine:

  • When stroke entered the differential diagnosis
  • When MRI was ordered
  • Whether MRI was feasible
  • Whether an alternate study was obtained
  • Whether transfer to a facility with advanced imaging was appropriate
  • Whether any delay changed treatment or outcome

A later diagnosis is not automatically malpractice.

For some perinatal strokes, there may be little or no acute treatment that could reverse the infarction after it has already occurred.

Causation therefore requires careful analysis.

Failure to Treat an Underlying Medical Cause

Seizures can result from treatable problems other than stroke.

An appropriate evaluation may involve consideration of:

  • Blood glucose
  • Electrolytes
  • Calcium
  • Infection
  • HIE
  • Hemorrhage
  • Metabolic disease
  • Genetic epilepsy

The relevant workup depends on the child’s presentation.

Failure to Control Significant Seizure Burden

Neonatal seizures themselves can be associated with ongoing neurological stress.

The International League Against Epilepsy recommends treating neonatal seizures, including electrographic-only seizures, with the goal of reducing seizure burden.

A possible case may therefore involve questions about:

  • When treatment was initiated
  • Medication selected
  • Loading doses
  • Response
  • Continued EEG monitoring
  • Whether seizures remained uncontrolled

The fact that a first medication did not work does not itself show negligence.

Neonatal seizures can be difficult to control even with appropriate treatment.

What Is the First-Line Treatment for Neonatal Seizures?

The International League Against Epilepsy’s 2023 guideline recommends phenobarbital as the first-line antiseizure medication for neonatal seizures requiring medication.

This includes seizures associated with common acute neonatal causes such as:

  • HIE
  • Stroke
  • Intracranial hemorrhage

There is an important exception.

If a channelopathy is strongly suspected—for example, because of a relevant family history—a sodium-channel-blocking medication may be considered instead.

Treatment should therefore be individualized.

What if Phenobarbital Does Not Stop the Seizures?

The ILAE identifies possible second-line medications including:

  • Phenytoin or fosphenytoin
  • Levetiracetam
  • Midazolam
  • Lidocaine

There is less evidence establishing one universally preferred second-line treatment.

The child’s:

  • Medical condition
  • Heart function
  • Suspected seizure cause
  • EEG pattern
  • Medication response

can influence the choice.

Is Levetiracetam the Standard First-Line Drug?

Not under the current ILAE neonatal seizure guideline.

Levetiracetam is widely used in pediatric neurology and can be an appropriate neonatal seizure medication in certain circumstances.

But the ILAE guideline recommends phenobarbital as the first-line medication for most neonatal seizures requiring drug therapy.

Should a Baby Stay on Seizure Medication After Leaving the NICU?

Not necessarily.

The ILAE recommends that when acute provoked neonatal seizures have stopped and there is no evidence of neonatal-onset epilepsy, antiseizure medication generally should be discontinued before discharge.

The recommendation applies regardless of MRI or EEG findings after the acute seizures have resolved.

This is a guideline recommendation and does not replace individualized medical judgment.

Some newborns have an epilepsy syndrome or other condition requiring ongoing treatment.

How Stroke Treatment Differs in Newborns

A newborn stroke is not managed exactly like an adult stroke.

The AHA/ASA’s neonatal stroke guidance emphasizes supportive care and treatment of associated problems such as:

  • Seizures
  • Oxygenation
  • Dehydration
  • Anemia

The role of antiplatelet or anticoagulant medication depends on the stroke type and risk of recurrence.

For many neonatal arterial ischemic strokes, routine anticoagulation or aspirin is not automatically indicated because recurrence risk can be relatively low.

Different considerations can apply when there is:

  • Cerebral venous thrombosis
  • Significant thrombophilia
  • Complex congenital heart disease
  • Another ongoing source of embolic risk

Stroke treatment is therefore highly individualized.

Can a Perinatal Stroke Cause Cerebral Palsy?

Yes.

Perinatal stroke is an important cause of childhood motor disability.

Depending on the location and size of the injury, a child may later develop:

  • Hemiplegic or hemiparetic cerebral palsy
  • Weakness on one side
  • Spasticity
  • Epilepsy
  • Language difficulties
  • Learning difficulties
  • Visual problems
  • Attention or executive-function challenges

Not every child with a perinatal stroke develops severe disability.

The long-term outcome depends on many factors.

Can Perinatal Stroke Cause Epilepsy?

Yes.

Some children who experience a perinatal stroke later develop recurrent unprovoked seizures and epilepsy.

Other children have acute neonatal seizures but never develop chronic epilepsy.

Ongoing neurology follow-up can help distinguish the two.

What Records Matter in a Perinatal Stroke or Neonatal Seizure Case?

These cases frequently require records from several medical specialties.

Prenatal Records

Request:

  • Complete prenatal chart
  • Maternal-fetal medicine records
  • Ultrasounds
  • Placental concerns
  • Infection records
  • Maternal medical conditions
  • Maternal clotting disorders
  • Fetal testing

Labor and Delivery Records

Potentially relevant evidence can include:

  • Labor and delivery chart
  • Nursing notes
  • Obstetric notes
  • Complete fetal heart rate tracings
  • Oxytocin and medication records
  • Maternal vital signs
  • Infection concerns
  • Delivery note
  • Placental pathology

Not every perinatal stroke is related to labor or fetal monitoring.

Those records are nevertheless often reviewed to understand the entire perinatal timeline.

Newborn Resuscitation Records

Request:

  • Apgar scores
  • Resuscitation sheet
  • Heart rate
  • Respiratory support
  • Oxygen
  • Intubation
  • Cord gases
  • Early blood gases

These records can help distinguish stroke from other causes of neonatal neurological dysfunction, including HIE.

Complete EEG Data

Request both:

  • Written EEG reports, and
  • The underlying digital EEG recording when it is available and can be preserved

Relevant evidence can include:

  • Continuous video-EEG
  • Routine EEG
  • aEEG
  • Seizure annotations
  • EEG technologist notes
  • Neurologist interpretations
  • Treatment-response documentation

The written report summarizes the study.

The underlying EEG data may allow another qualified neurophysiologist to independently review seizure timing and burden.

Seizure Logs

Request:

  • Bedside seizure documentation
  • Nursing event logs
  • EEG event markers
  • Family-reported events
  • Video when part of medical monitoring

Medication Records

Preserve:

  • Medication administration record
  • Phenobarbital loading dose
  • Additional loading doses
  • Blood levels when obtained
  • Phenytoin/fosphenytoin
  • Levetiracetam
  • Midazolam
  • Lidocaine
  • Other antiseizure medications
  • Response after each medication

Brain Imaging

Request both the report and, when possible, the actual imaging files for:

  • MRI
  • MRA
  • MRV
  • CT
  • Cranial ultrasound

Actual imaging may be important for an independent neuroradiology review.

Neurology Records

Request:

  • Initial consultation
  • Daily progress notes
  • Stroke assessment
  • Seizure assessment
  • Follow-up recommendations
  • Epilepsy consultations

Stroke Evaluation Records

Depending on the case, potentially relevant evidence can include:

  • Echocardiography
  • Cardiology consultation
  • Coagulation studies
  • Thrombophilia testing
  • Infection studies
  • Placental pathology
  • Hematology evaluation

Not every test is medically indicated in every newborn.

Transfer Records

If the baby was transferred to another hospital, preserve:

  • Referral calls
  • Accepting physician notes
  • Transport activation
  • Transport-team records
  • Time transfer was requested
  • Time the team arrived
  • Treatments during transport
  • Time of arrival

Long-Term Records

Save records from:

  • Pediatric neurology
  • Epilepsy clinic
  • Physical medicine and rehabilitation
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Developmental pediatrics
  • Orthopedics
  • Vision specialists
  • Neuropsychological testing
  • School evaluations
  • IEPs

Why Exact EEG Timestamps Can Matter

A stroke-and-seizure case often requires a minute-by-minute or hour-by-hour chronology.

Important times can include:

  • First unusual movement
  • First bedside documentation
  • First physician notification
  • Neurology consultation
  • EEG order
  • EEG hookup
  • First electrographic seizure
  • Time the seizure was recognized on review
  • Medication order
  • Medication administration
  • Seizure cessation

A delay in one of those events does not automatically establish malpractice.

Experts must determine whether the delay was unreasonable and whether an earlier intervention would more likely than not have improved the outcome.

Why Preserving the Actual MRI Matters

An MRI report is one radiologist’s interpretation.

The actual imaging allows another specialist to evaluate:

  • Stroke distribution
  • Arterial territory
  • Venous pattern
  • Hemorrhage
  • Restricted diffusion
  • Other areas of brain injury
  • Alternative diagnoses

In a legal investigation, a pediatric neuroradiologist may need to independently review those images.

What Kentucky Parents Can Do After a Neonatal Stroke or Seizure Diagnosis

1. Ask the Team to Explain the Diagnosis

Useful questions can include:

  • Was this definitely a seizure?
  • Was it confirmed by EEG?
  • Is continuous EEG being used?
  • Has a stroke been confirmed?
  • What type of stroke occurred?
  • What did the MRI show?
  • Is a venous clot involved?
  • What is believed to have caused the stroke?
  • Are additional tests needed?

2. Ask Whether cEEG Is Appropriate

For a newborn with suspected seizures or a neurological condition carrying a substantial seizure risk, ask the medical team whether continuous EEG would provide useful information.

The decision depends on the baby’s condition and available resources.

3. Request the Complete Record

Do not rely solely on patient-portal documents.

Request records from:

  • Birth hospital
  • NICU
  • Neurology
  • Radiology
  • EEG/neurodiagnostic department
  • Transport service
  • Receiving hospital
  • Follow-up specialists

4. Specifically Request EEG Recordings

If possible, ask whether the digital EEG recording itself can be preserved or provided.

Some systems may have retention limits.

5. Preserve the Actual MRI

Ask how to obtain the child’s imaging in a format that another physician can review.

6. Build a Timeline

Write down:

  • What you first noticed
  • What nurses or physicians said
  • When seizure concern began
  • When EEG started
  • When stroke was mentioned
  • When MRI occurred
  • When medication was given
  • When transfer occurred

7. Continue Neurological and Developmental Follow-Up

Some effects of perinatal stroke do not become fully apparent during the newborn hospitalization.

Keep records of:

  • Motor milestones
  • Hand preference
  • Strength differences
  • Therapy
  • Seizures
  • Language development
  • Vision
  • Learning
  • School support

8. Ask About Kentucky Early Intervention

Kentucky’s Kentucky Early Intervention System (KEIS) provides services for eligible children from birth to age 3 with developmental disabilities, delays, or certain qualifying conditions.

Families do not need to wait for a legal investigation before seeking appropriate developmental services.

9. Have Kentucky Deadlines Evaluated Early

Medical malpractice deadlines depend on the claimant, defendants, and legal forum.

Do not assume every claim involving an infant is automatically preserved until adulthood.

Kentucky Neurological and NICU Resources

A critically ill newborn with stroke or seizures may require neonatology, neurology, advanced neuroimaging, and EEG monitoring.

Whether a baby should be transferred is a medical decision made by the treating team.

Golisano Children’s at UK — Lexington

Kentucky Children’s Hospital is now Golisano Children’s at UK.

Its Lexington neonatal intensive care unit is a Level IV NICU.

UK HealthCare specifically states that its Child Neurology team treats neurological problems of neonates—including seizures, strokes, and hypoxic injuries—in conjunction with UK Neonatology.

UK also provides pediatric epilepsy and neurological services through the Kentucky Neuroscience Institute.

Kentucky Kids Crew

UK HealthCare operates the Kentucky Kids Crew, providing neonatal and pediatric hospital-to-hospital critical-care transport by ground or air.

The service is available 24 hours a day, seven days a week.

Norton Children’s — Louisville

Norton Children’s Hospital operates a Level IV NICU in Louisville.

The Norton Children’s Neuroscience Institute provides pediatric neurology care for conditions including:

  • Seizures
  • Epilepsy
  • Stroke
  • Other neurological disorders

Norton Children’s also operates dedicated EEG and epilepsy-monitoring services for pediatric patients.

“Just for Kids” Transport Team

The Norton Children’s “Just for Kids” Transport Team provides specialized neonatal and pediatric inter-hospital transportation.

These hospitals and programs are identified as Kentucky treatment resources only.

Their inclusion does not suggest negligence or wrongdoing by either health system or any provider.

Kentucky Law and Perinatal Stroke Birth Injury Claims

Kentucky’s Current Medical Malpractice Deadline

Kentucky’s current KRS 413.140, effective July 15, 2026, generally requires a negligence or malpractice action against a covered physician, surgeon, dentist, or hospital to be commenced within one year after the cause of action accrues.

For covered medical malpractice claims, the statute provides that the claim accrues when the injury is:

  • First discovered, or
  • Through reasonable care should have been discovered.

The statute also contains a five-year outside limitation measured from the alleged negligent act or omission.

The correct deadline depends on the particular claim and defendant.

Does Kentucky Toll a Newborn’s Claim?

KRS 413.170 provides tolling for certain claims when the person entitled to bring the action was an infant—meaning a minor—when the claim accrued.

Because KRS 413.140 falls within the statutory range addressed by KRS 413.170, minority can significantly affect a child’s own medical malpractice claim.

But it is too broad to say that every legal claim connected with a newborn stroke can wait until the child’s eighteenth birthday.

Different rules may apply to:

  • A parent’s independent claim
  • An estate claim
  • Wrongful death
  • Governmental defendants
  • State institutions
  • State employees
  • Claims governed by a separate statutory process

Each potential claim should be analyzed separately.

Special Rules Can Apply to UK HealthCare and Other State Institutions

This issue is particularly relevant to Kentucky families receiving treatment through the University of Kentucky.

Under KRS 49.070, Kentucky treats state institutions of higher education as state agencies for purposes of the Board of Claims statutes.

The Kentucky Board of Claims has primary and exclusive jurisdiction over certain negligence claims involving the Commonwealth, its agencies, and employees acting within the scope of state employment.

KRS 49.120 contains separate limitations rules.

For medical malpractice claims before the Board:

  • Claims generally must be filed within one year after accrual.
  • Medical malpractice claims use a discovery rule.
  • The statute contains a three-year outside limitation.
  • A guardian, next friend, or other qualified representative must bring a minor’s claim within the applicable Board deadline.

Importantly, KRS 49.120 expressly states that its disability provision applies notwithstanding KRS 413.170.

Families therefore should not assume that ordinary infancy tolling governs a potential claim involving a state institution.

Whether a particular UK HealthCare physician, employee, contractor, entity, or claim actually falls within Board of Claims jurisdiction requires individualized legal analysis.

Kentucky’s Certificate-of-Merit Requirement

Under KRS 411.167, a claimant beginning many Kentucky medical malpractice lawsuits generally must file a certificate of merit with the complaint.

The certificate ordinarily states that:

  • The claimant has reviewed the facts
  • The claimant or attorney consulted with at least one qualified expert
  • The expert is knowledgeable about the relevant issues
  • The consultation supports a reasonable basis for commencing the action

The statute includes exceptions and alternative procedures.

It also addresses situations in which requested medical records have not yet been produced.

For a neurological birth injury case, obtaining the complete hospital, EEG, imaging, and treatment record early can therefore be important both medically and legally.

Does Kentucky Require a Medical Review Panel?

No.

Kentucky previously enacted a mandatory medical review panel system.

The Kentucky Supreme Court held that law unconstitutional in Commonwealth ex rel. Meier v. Claycomb.

The former medical review panel process is therefore not required.

That should not be confused with the separate certificate-of-merit requirement under KRS 411.167.

Do Perinatal Stroke Cases Require Medical Experts?

Usually.

These cases can involve highly specialized questions concerning:

  • Neonatology
  • Pediatric neurology
  • Neonatal neurophysiology
  • Neuroradiology
  • Obstetrics
  • Hematology
  • Pediatric cardiology
  • Placental pathology
  • Stroke causation
  • Seizure treatment
  • Long-term prognosis

Kentucky’s KRE 702, as amended effective July 1, 2024, governs expert testimony.

Experts generally must address more than whether the stroke or seizure happened.

They may need to explain:

  1. What the applicable standard of care required.
  2. Whether the care departed from that standard.
  3. Whether that departure actually caused additional neurological injury.
  4. What portion of the child’s outcome resulted from the underlying stroke itself.

That causation distinction can be especially important because a stroke may already have injured brain tissue before medical personnel had any reasonable opportunity to diagnose it.

Do AHA, ACNS, or ILAE Guidelines Automatically Establish Malpractice?

No.

Professional guidelines provide important clinical context.

They do not automatically establish the legal standard of care or prove negligence in an individual case.

For example:

  • ACNS’s 2025 cEEG recommendations are conditional.
  • EEG availability can differ among hospitals.
  • A stroke can be difficult to recognize immediately.
  • Treatment options depend on stroke type.
  • Some neonatal seizures remain difficult to control despite appropriate medication.

Qualified experts must evaluate the actual circumstances.

Who Could Be Responsible for Preventable Stroke- or Seizure-Related Harm?

Depending on the evidence, a medical investigation may examine care provided by:

  • Obstetricians
  • Maternal-fetal medicine physicians
  • Labor and delivery nurses
  • Newborn nursery physicians
  • Neonatologists
  • Pediatricians
  • Neurologists
  • Radiologists or neuroradiologists
  • Hospitals or health systems

Potential institutional issues may involve:

  • Access to EEG
  • Neurodiagnostic staffing
  • Neurology consultation systems
  • Imaging availability
  • Critical-result communication
  • Transfer procedures
  • NICU capabilities

The involvement of a provider or institution does not establish liability.

Can the Hospital Be Responsible or Only the Doctor?

Potentially either, both, or neither.

Questions may include:

  • Who was responsible for evaluating the neurological symptoms?
  • Who received an abnormal EEG or imaging result?
  • Was a delay caused by an individual medical decision or a hospital system?
  • Was neurological consultation available?
  • Was transfer required?
  • Who employed each provider?
  • Was the provider an employee, agent, independent contractor, or state employee?

Those facts can affect liability and the proper legal forum.

What Long-Term Problems Can Follow Perinatal Stroke?

Outcomes vary substantially.

Potential effects can include:

  • Hemiplegic cerebral palsy
  • Weakness on one side
  • Spasticity
  • Epilepsy
  • Developmental delay
  • Language difficulties
  • Learning disabilities
  • Attention or executive-function difficulties
  • Visual impairment
  • Fine-motor difficulties
  • Need for orthotics or assistive devices

Some children function very well with relatively limited impairment.

Others require long-term medical, educational, and personal support.

What Damages Could Be Involved in a Supported Kentucky Claim?

Depending on the evidence and Kentucky law, claimed damages may involve:

  • Past medical expenses
  • Future medical care
  • Neurology treatment
  • Epilepsy medication
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Orthopedic treatment
  • Assistive devices
  • Mobility equipment
  • Special-education support
  • Home or vehicle modifications
  • Personal-care assistance
  • Lost or diminished future earning capacity
  • Other legally compensable harms

Serious cases may require physicians, therapists, life-care planners, economists, vocational experts, and other specialists.

There is no responsible way to value a claim based only on the diagnosis of “perinatal stroke.”

What if a Stroke Results in a Newborn’s Death?

Kentucky wrongful-death claims are governed in part by KRS 411.130.

The action is prosecuted by the deceased person’s personal representative.

Wrongful-death claims involve deadlines and procedures different from a living child’s personal malpractice claim.

Parents should therefore not assume that the ordinary minority-tolling discussion controls a fatal-injury case.

Frequently Asked Questions About Perinatal Stroke and Neonatal Seizures

How common is perinatal stroke?

The AHA/ASA cites a newborn stroke risk of approximately 1 in 4,000 live births.

Estimates vary depending on stroke definition and whether children diagnosed later are included.

What is the most common sign of a neonatal arterial stroke?

Seizures are a common presentation.

The AHA/ASA notes that neonatal arterial ischemic stroke frequently presents with focal motor seizures.

Does an early hand preference mean my newborn had a stroke?

An unusually early hand preference can be a later clue to a previously unrecognized perinatal stroke.

It is generally noticed months after birth rather than during the immediate newborn period.

Are all neonatal seizures visible?

No.

Some seizures are electrographic-only and may not have an obvious visible manifestation.

Is cEEG better than simply watching the baby?

For clinically suspected neonatal seizures, the 2025 ACNS guideline conditionally suggests cEEG to improve diagnostic accuracy compared with clinical observation alone, aEEG alone, or a short routine EEG.

Is aEEG useless?

No.

aEEG can be a valuable bedside neuromonitoring tool.

However, ACNS recommends confirming suspected aEEG seizure events with conventional cEEG.

Which newborns may need seizure screening with cEEG?

ACNS suggests cEEG for certain newborns at high risk for seizures.

Evidence supports monitoring in clinical groups that include acute ischemic stroke, HIE, intracranial hemorrhage, encephalopathy, and some other high-risk conditions.

The recommendation is conditional and depends on clinical circumstances.

What imaging is used for a neonatal stroke?

MRI is particularly important for diagnosing neonatal stroke.

MRA or MRV may also be performed to evaluate arteries or cerebral veins.

The appropriate study depends on the suspected type of stroke.

What is the first-line medicine for neonatal seizures?

The ILAE recommends phenobarbital as first-line treatment for most neonatal seizures requiring medication.

An exception can apply when an inherited channelopathy is strongly suspected.

What if phenobarbital does not work?

Potential second-line options include phenytoin/fosphenytoin, levetiracetam, midazolam, and lidocaine.

The choice depends on the child’s condition and suspected seizure cause.

Does every baby with an acute seizure need lifelong medication?

No.

The ILAE recommends discontinuing antiseizure medication before discharge after resolved acute provoked neonatal seizures when there is no evidence of neonatal-onset epilepsy.

Does a delay in diagnosing stroke automatically mean malpractice?

No.

Perinatal stroke can be difficult to recognize, and some strokes are not clinically apparent during the newborn period.

A legal claim requires evidence that the evaluation fell below the applicable standard of care and that an earlier diagnosis or treatment would more likely than not have prevented additional injury.

Can a perinatal stroke cause cerebral palsy?

Yes.

Perinatal stroke is one recognized cause of hemiplegic or hemiparetic cerebral palsy.

Can a perinatal stroke cause epilepsy?

Yes.

Some children develop epilepsy after perinatal stroke, while others have only acute neonatal seizures.

Where can newborns with stroke or seizures receive advanced care in Kentucky?

Kentucky resources include:

  • Golisano Children’s at UK in Lexington, with a Level IV NICU and child neurologists who specifically treat neurological problems of neonates, including seizures and stroke.
  • Norton Children’s Hospital in Louisville, with a Level IV NICU and pediatric neurology, epilepsy, EEG, and neuroscience services.

Whether a particular newborn needs transfer is a medical decision.

What is Kentucky’s deadline for a perinatal stroke malpractice case?

KRS 413.140 generally provides a one-year period for covered private medical malpractice claims, along with a discovery rule and a five-year outside limitation.

KRS 413.170 can affect certain claims belonging to minors.

Different rules apply in some circumstances, including state institutions, wrongful death, and parents’ independent claims.

There is no single safe deadline for every case.

Does Kentucky require a medical review panel?

No.

Kentucky’s former mandatory medical review panel statute was held unconstitutional.

Does Kentucky require a certificate of merit?

For many covered medical malpractice actions, yes.

KRS 411.167 generally requires a certificate of merit with the complaint, subject to the statute’s exceptions and alternative procedures.

Do I need medical experts?

Usually.

Perinatal stroke and neonatal seizure cases often require experts in neurology, neonatology, EEG interpretation, neuroradiology, obstetrics, or other specialties.

How Morrin Law Office Evaluates a Perinatal Stroke or Neonatal Seizure Case

A stroke or seizure investigation should begin with the neurological evidence rather than the assumption that every diagnosis resulted from negligence.

Our review may involve:

  1. Obtaining complete prenatal, labor, delivery, and newborn records.
  2. Preserving the complete fetal monitoring record when relevant.
  3. Obtaining the neonatal resuscitation record and cord gases.
  4. Preserving all EEG reports and available digital EEG recordings.
  5. Building a timeline of suspected clinical and electrographic seizures.
  6. Reviewing antiseizure medication orders and responses.
  7. Obtaining the actual MRI, MRA, MRV, CT, and ultrasound images.
  8. Determining the stroke type, location, and likely timing.
  9. Reviewing neurological, hematological, cardiac, infectious, and placental evidence when relevant.
  10. Evaluating alternative causes of the child’s neurological condition.
  11. Reviewing NICU escalation and transfer timing.
  12. Consulting qualified neonatal neurology, neurophysiology, neuroradiology, and other experts as appropriate.
  13. Determining whether any delay actually caused additional injury beyond the underlying stroke.
  14. Identifying potentially responsible providers and healthcare entities.
  15. Determining whether ordinary Kentucky court procedures or Board of Claims rules may apply.
  16. Evaluating Kentucky’s certificate-of-merit requirement and applicable filing deadlines.
  17. Documenting long-term seizures, cerebral palsy, therapy, development, education, and future-care needs.

Some perinatal strokes occur without any preventable medical error.

Some neonatal seizures are difficult to detect or control even with appropriate care.

Other cases may support a conclusion that an unreasonable delay in neurological evaluation, EEG monitoring, treatment, imaging, or escalation contributed to additional harm.

The purpose of a careful investigation is to determine what the records and qualified medical experts actually support.

Talk With Morrin Law Office About a Perinatal Stroke or Neonatal Seizure

If your child experienced a perinatal stroke, neonatal seizures, cerebral palsy, epilepsy, or another serious neurological condition and you have questions about what occurred during birth or newborn care, Morrin Law Office can review the available information and discuss whether further investigation makes sense.

Morrin Law Office
214 W. Main St.
Richmond, KY 40475
Phone: 859-358-0300

Sources

Disclaimer

This page provides general public information about perinatal stroke, neonatal seizures, EEG monitoring, birth injury, and Kentucky medical malpractice law. It is not medical advice or legal advice.

Perinatal stroke and neonatal seizures can occur even when appropriate medical care is provided. Diagnosis can be difficult, and treatment depends on the type of stroke, seizure cause, clinical condition, and available medical resources.

Medical guidance, laws, filing requirements, and deadlines can change. If a newborn is currently showing possible seizure activity or other neurological symptoms, seek appropriate medical care. If you have questions about potential legal rights or filing deadlines, consider obtaining individualized legal advice promptly.

Recent Posts

Meconium Aspiration in Kentucky Births

Aug 25, 2026 |

When doctors or nurses say that there was meconium in the amniotic fluid, parents may immediately worry that their baby swallowed or inhaled stool during delivery. Meconium-stained amniotic fluid and meconium aspiration syndrome (MAS) are related, but they are not the...

Birth Injuries

0 Comments

Morrin Law Office

August 25, 2026

0 Comments