Focal Arterial Infarction and Lobar Hemorrhage in Term Infants

Perinatal arterial ischemic stroke is a relatively common and serious neurological disorder. It can carry significant long-term disabilities. Here we describe the current understanding of its etiology, pathophysiology, and classification, its different presentations, and optimal early management. We discuss the role of brain imaging in defining the extent of lesions and the impact this has on the prediction of outcomes. An overview is given of the range of possible outcomes and optimal approaches to follow-up and support for the child and their family. Large focal lobar hemorrhage occurs less often than perinatal arterial ischemic stroke and does not follow arterial territories. The presentation can be very similar. The hemorrhage is usually well seen on initial cranial ultrasound scan, unlike stroke, and the sites are often frontal or temporal. Brain imaging is diagnostic and prognostic of outcomes.