The International Pediatric Stroke Study, a global research initiative of 149 co-investigators (30 centers in 10 countries), examined predictors of infarct characteristics and outcome in patients with clinical and neuroimaging confirmation of symptomatic arterial ischemic stroke (AIS). Of 248 neonates enrolled 2003-2007, 57% were male and 10% premature. Seizure was the presenting feature in 72% and nonfocal neurologic signs in 63%. Vascular imaging infarcts on MRI, involving the anterior circulation and left hemisphere preferentially, were multifocal in 30%. Maternal health and pregnancies were usually normal. Neonates required resuscitation in 30% and systemic illnesses were associated in 23%. Cardiac and prothrombotic abnormalities were found in <20%, and antithrombotic treatment was used in only 21%. Short-term outcome at discharge was poor, with deficits in 49%. Long-term outcomes are pending. [1]

COMMENT. Neonates with arterial ischemic stroke (AIS) are often systemically ill, whereas their mothers are usually well. Risk factors for perinatal stroke include cardiac disorders, coagulation disorders, infection, trauma, drugs, maternal and placental disorders, and perinatal asphyxia [2]. The risk of perinatal arterial ischemic stroke increases dramatically with multiple risk factors. Long-term disabilities are frequent, and include cerebral palsy and cognitive impairments. Estimates of the incidence of cerebral palsy after AIS vary widely from 9% to 88%. Although many neonates with AIS present with seizures, most do not develop epilepsy [3]. After perinatal brain injury, children tend to “grow into their defects,” and the diagnosis of cerebral palsy is often delayed until 18 to 24 months; learning and behavior impairments are not appreciated until school age. [4]