One page summary: Perinatal stroke

In two sentences

A perinatal stroke is a blocked or bleeding blood vessel in a baby's brain, occurring from late in pregnancy through the first month after birth. ¹

Most perinatal strokes are found in one of two ways: seizures in the first few days of life, or an early hand preference noticed months later. In most cases no cause is ever identified, and in most cases nothing the parents did or did not do had anything to do with it. ¹

The numbers, with their sources

• How common. Perinatal stroke is among the most common causes of hemiplegic cerebral palsy, and it is far more common in newborns than at any other point in childhood ¹
• The most common first sign. Seizures in the first few days of life, often affecting one side of the body ¹
• The most common later sign. A clear hand preference before 12 months, which is not typical development and should be evaluated ²
• The most affected vessel. The middle cerebral artery, most often on the left side, which is why right-sided weakness is the common pattern ¹
• The right test. MRI, including diffusion-weighted imaging, which shows a fresh stroke in the first days. Ultrasound often misses it ³
• Cause. In most cases no single cause is identified, and a combination of factors is usually assumed ¹

What to do this week

1. Ask for the MRI report, including which artery territory and which side.
2. Ask whether an EEG was done and what it showed.
3. Ask what the plan is for stopping seizure medicine, if your baby is on it.
4. Ask about constraint-induced movement therapy and at what age your center offers it.
5. Refer to early intervention now. ⁴
6. Ask whether the placenta was examined, since placental pathology sometimes explains a stroke.
7. If your child is older and you have noticed a hand preference, say so today. Before 12 months it is a finding, not a quirk. ²

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the neonatologist or neurologist

• Which artery territory, which side, and how large?
• Did the EEG show seizures we could not see?
• What tests were done to look for a cause, and did any change treatment?
• When do we stop the seizure medicine?
• What should we watch for over the next year?

For the therapy team

• When can we start constraint-induced therapy?
• What do we do at home for the affected hand?
• Should my child have a brace, and what is it for?
• How will we measure whether the arm is improving?

For the ophthalmologist

• Is any part of the visual field affected?
• How would we notice that at home?
• When should we recheck?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on Perinatal stroke

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.