Bilateral perinatal arterial stroke in a neonate.

To cite: Sashikumar P, Gupta R, Conry B. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013202059 DESCRIPTION Perinatal arterial ischaemic stroke (PAIS) is the cause for 10–15% of neonatal seizures and approximately 30% of childhood hemiplegia. We report a case of bilateral arterial stroke which initially was thought to be hemimegalencephaly and unilateral arterial stroke. A term baby was noticed to have paucity of movements of his right upper limb in the immediate postnatal period. A brain MRI on day 7 showed large porencephalic cyst involving the entire territory of the left middle cerebral artery (MCA). There was also a shift of the midline to the left due to a mass effect from the right hemisphere (figure 1A, B). Provisional diagnosis of antenatal left-sided PAIS and rightsided hemimegalencephaly was made following opinion from tertiary paediatric neurologist. Parents denied further investigations at this stage. Baby developed infantile spasms at 3 months of age. MRI at 7 months showed new porencephaly on the right side in addition to the previous left side porencephaly (figure 1C, D). This clarified that the initial presumed right hemimegalencephaly was an MCA and anterior cerebral artery territory infarction in evolution with a contralateral left infarct already well-established at birth.