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Updated: Jan 19, 2026
Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
Long-Term Outcome After Bilateral Perinatal Arterial Ischemic Stroke
Aleksandra Mineyko1, Adam Kirton1
1Section of Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Neurology, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Insights
Children with bilateral large vessel perinatal arterial ischemic stroke face severe cognitive and motor deficits. Epilepsy is also more common in these cases, requiring careful prognosis discussions with families.
Area of Science:
- Neurology
- Pediatrics
- Neonatal care
Background:
- Perinatal arterial ischemic stroke (PAIS) affects newborns.
- Bilateral large vessel involvement is a rare but severe form of PAIS.
Purpose of the Study:
- To characterize the phenotype and outcomes of children with bilateral, large vessel perinatal arterial ischemic stroke.
- To assess the long-term sequelae and epilepsy risk in this specific pediatric stroke population.
Main Methods:
- Retrospective analysis of a population-based cohort (Alberta Perinatal Stroke Project).
- Inclusion criteria: stroke in major cerebral artery territories in both hemispheres on MRI.
- Outcomes assessed using standardized measures: Pediatric Stroke Outcome Measure, Gross Motor Function Classification System, and epilepsy frequency.
Main Results:
- Eight of 174 (5%) children had bilateral large vessel PAIS.
- Mean follow-up was 9.7 years; one mortality.
- All children exhibited significant motor deficits (GMFCS ≥ II) and cognitive impairment (PSOM ≥ 2); 88% had epilepsy.
Conclusions:
- Bilateral large vessel PAIS is associated with a high risk of severe neurodevelopmental impairments.
- Epilepsy appears more prevalent compared to unilateral strokes.
- Prognosis discussions with families should be approached with caution due to the severity of outcomes.
Aim:
We aimed to characterize the phenotype and outcome of children with bilateral, large vessel perinatal arterial ischemic stroke.
Methods:
Patients with bilateral, large vessel perinatal arterial ischemic stroke were identified from a large, population-based cohort (Alberta Perinatal Stroke Project). Subjects were included if stroke involving a major cerebral artery territory was documented in both cerebral hemispheres on magnetic resonance imaging. Standardized variables were extracted from charts including clinical presentations, associated potential risk factors, and outcomes. Outcome measures included the Pediatric Stroke Outcome Measure, Gross Motor Function Classification System, and epilepsy frequency score. Electroencephalographies were reviewed for sleep, epileptiform activity, and background.
Results:
Of 174 children with perinatal arterial ischemic stroke, eight (5%) had bilateral large artery infarcts. Patients were followed for a mean of 9.7 years (range 1.8 to 14.6 years). One child died. All children had a total Pediatric Stroke Outcome Measure of ≥2 (median 8, range 2 to 10) and Gross Motor Function Classification System ≥ II. Seven of eight (88%) children had a history of epilepsy.
Conclusions:
Children with bilateral, large vessel perinatal stroke are at high risk of severe cognitive and motor sequelae. Epilepsy may also be more common than unilateral strokes. Cautious discussions with families regarding prognosis are recommended.
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