Perinatal arterial ischaemic stroke in term babies

Perinatal arterial ischaemic stroke (PAIS) affects between 1:2300 and 1:4000 births, so most paediatricians and neonatologists will see a number of cases during their working life. The exact cause of PAIS in an individual usually is unknown, and discussion may occur about whether prothrombotic investigations, aspirin or anticoagulation are needed. The causes, investigation and treatment of PAIS are completely different from stroke in the older paediatric and adult group. Outcome tends to be good, although cerebral palsy may be seen in up to 30% of cases, epilepsy in 15-25% and cognitive problems may also occur. Fortunately, EEG and MRI can help identify those children with PAIS at the highest risk of neuro-developmental difficulties. This paper reviews what we know about the potential mechanisms causing PAIS, what investigations are necessary, and the likely outcome for the child.