Frequency and Distribution of Perinatal Arterial Ischemic Stroke in a Cohort of Patients with Cerebral Palsy Using Delayed MRI

Purpose This study examined the occurrence and MRI characteristics of perinatal arterial ischemic stroke (PAIS) in children with cerebral palsy (CP) and suspected term hypoxic-ischemic injury (HII). Methods A retrospective review of brain MRI scans was conducted on children with CP and suspected term HII in South Africa. Results Out of 1620 children with CP included in the study, 15 (0.9%) had PAIS. The most common site of infarct was the left middle cerebral artery. The majority of infarcts were unilateral, and 67% of cases exhibited cystic changes. Among children with PAIS, 47% exhibited concurrent HII, with the predominant patterns being basal-ganglia-thalamus (BGT) and watershed (WS). In cases of isolated PAIS (53%), network injuries were prevalent in 88% of children, most commonly involving the posterior limbs of the internal capsule, cerebral peduncles, thalami, and corpus callosum. Conclusions The study highlights that PAIS is a relatively rare condition in children with CP, predominantly occurring in the left middle cerebral artery.