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.