Life After Perinatal Stroke

Perinatal strokes are a well-defined group of cerebrovascular diseases that damage the brain early in life and account for most cases of hemiparetic cerebral palsy. The motor deficits are now sufficiently researched to inform early prognostication, the construction of developmental plasticity models, and new clinical trials. Nonmotor outcomes are more complex and are challenging to measure given their emergence with time during developmental maturation. Several fundamental gaps in the understanding of perinatal stroke outcomes are of essential clinical relevance. How can 2 children with virtually identical brain lesions acquired at the same time have extremely different outcomes? How does a child develop new skills that his or her brain has never possessed during stroke recovery? How do we measure outcome as the child continues to grow into deficits with maturation? What are the modulators of developmental plasticity that might be targeted to achieve better functional outcomes? We review the current state of knowledge on perinatal stroke outcomes and attempt to highlight elements that might provide insight into these pressing questions.The most focused lifetime risk for stroke is the week surrounding birth.1 A term newborn carries a risk of ischemic stroke of ≥1:3500, triple the weekly stroke risk of a smoking adult with diabetes mellitus and hypertension.1,2 Adding in populations of neonatal hemorrhagic stroke, sinovenous thrombosis, and late presenting presumed perinatal strokes likely more than doubles the incidence of perinatal stroke.3,4 Outcomes are generally poor with disability often lasting an entire lifetime, resulting in a large global burden of disease. Perinatal stroke is the most common cause of hemiparetic cerebral palsy, and many survivors have additional neurological sequelae including intellectual disabilities, developmental and behavioral disorders, and epilepsy. Identification of a causative factor for perinatal stroke remains elusive in most cases1 with no …