Objective: To investigate neurodevelopmental outcome in preterm and full-term infants who suffered perinatal arterial stroke (PAS).

Methods: Seventy newborn infants with PAS were admitted to the neonatal intensive care unit, between 1990 and 2005. Middle cerebral artery (MCA) infarct was divided into main branch, cortical branch or lenticulostriate branch involvement. All infants were assessed in the neonatal period with cranial ultrasound and 55 also with neonatal magnetic resonance imaging. Age range at follow-up was 24–120 months (mean 43.6 months). A Griffiths developmental assessment test was available at 24 months in all 65 survivors.

Results: Involvement of the main branch of the MCA was seen in six preterm and six full-term infants and was associated with the most adverse outcome. All developed hemiplegia (100%), six developed epilepsy (50%), with hypsarrythmia in three. Twenty-two had MCA–cortical branch involvement (16 full-term and six preterm), seven developed hemiplegia (32%) and two epilepsy. Lenticulostriate branch involvement was seen in 18 (nine full-term and nine preterm). Five developed hemiplegia (28%), which tended to be mild and only one developed epilepsy. Thirteen had either a PCA or ACA infarction. Only one developed mild hemiplegia and none developed epilepsy. A significantly lower DQ (mean ± SD) was found (82 ± 12) between those with main branch involvement compared with involvement of the other branches or PCA/ACA infarction (101 ± 10).

Conclusion: Taking into account which branch of the MCA is involved helps to predict the risk of developing hemiplegia. As expected, main branch involvement was associated with more adverse sequelae.