Diagnostic Course and Clinical Characteristics of Severe Cerebral Palsy Associated With Perinatal Cerebral Infarction: A Nationwide Registry-Based Study in Japan.
Ogoyama M, Takahashi H, et al. • The journal of obstetrics and gynaecology research • 2026
Neonatally and post-neonatally diagnosed cases of severe cerebral palsy associated with perinatal cerebral infarction showed similar timing of motor impairment recognition and frequency of severe brain injury findings, suggesting that differences in diagnostic timing primarily reflect different clinical triggers for neuroimaging rather than differences in underlying injury.
Key Findings
Results
Among 85 cases of cerebral infarction-associated severe cerebral palsy, neonatally diagnosed cases accounted for 47.1% and post-neonatally diagnosed cases for 51.8%, with 1 case diagnosed prenatally.
Data were drawn from the Japan Obstetric Compensation System for Cerebral Palsy registry between 2009 and 2022.
Total of 85 cases of cerebral infarction were analyzed.
This was a retrospective registry-based study design.
Results
Neonatal diagnosis of cerebral infarction was more frequently triggered by seizures, apnea, respiratory distress, or neuroimaging during NICU hospitalization, whereas most post-neonatal diagnoses followed recognition of motor impairment.
The two groups differed substantially in the clinical triggers prompting neuroimaging that led to diagnosis.
Post-neonatal diagnoses were predominantly initiated by parental or clinician recognition of motor developmental delay or impairment.
These findings reflect different clinical pathways to diagnosis rather than differences in the underlying cerebral injury.
Results
Neonatally diagnosed cases more frequently exhibited non-reassuring fetal status, lower umbilical artery pH, lower Apgar scores, and neonatal asphyxia compared to post-neonatally diagnosed cases.
Non-reassuring fetal status, umbilical artery pH, Apgar scores, and neonatal asphyxia were all more common or more abnormal in the neonatally diagnosed group.
These perinatal indicators of compromise distinguished the two diagnostic timing groups.
Despite these differences in perinatal condition, the two groups did not differ significantly in longer-term neurological outcomes as measured by motor impairment recognition timing and severe brain injury findings.
Results
No significant differences were observed in median age at recognition of motor impairment between neonatally and post-neonatally diagnosed cases, with a median of 7 months in both groups.
Median age at recognition of motor impairment was 7 months in both the neonatally diagnosed and post-neonatally diagnosed groups.
This similarity persisted despite the markedly different clinical presentations and perinatal profiles of the two groups.
The authors interpret this finding as suggesting that differences in diagnostic timing primarily reflect different clinical triggers for neuroimaging rather than differences in the severity or timing of the underlying cerebral injury.
Results
No significant differences were observed in the frequency of severe brain injury findings between neonatally and post-neonatally diagnosed cases.
Severity of brain injury on neuroimaging did not significantly differ between the two diagnostic timing groups.
This finding, combined with similar motor impairment recognition timing, supports the conclusion that diagnostic timing reflects clinical triggers rather than injury characteristics.
The authors suggest that earlier neonatal diagnosis did not correspond to a distinctly more severe injury pattern.
Results
Potential contributing conditions to perinatal cerebral infarction were identified in only 15.3% of cases, with etiology and timing of infarction onset remaining unclear in the majority.
Contributing conditions were identified in 15.3% of the 85 cases analyzed.
The etiology and timing of infarction onset remained unclear in many cases.
This low rate of identified contributing conditions highlights the diagnostic challenge of perinatal cerebral infarction.
What This Means
This research examined 85 children in Japan who developed severe cerebral palsy associated with perinatal cerebral infarction (a stroke-like injury occurring around the time of birth), using data from a national compensation registry collected between 2009 and 2022. The study found that roughly half of cases were diagnosed during the newborn period (typically because the baby had seizures, breathing problems, or worrying signs requiring brain scans in the NICU), while the other half were not diagnosed until after the newborn period, usually when parents or doctors noticed that the child was not moving normally. Babies diagnosed as newborns tended to have more obvious signs of birth stress, such as lower oxygen levels and lower Apgar scores.
Despite these differences in how and when the brain injury was discovered, the two groups of children were remarkably similar in important ways: both groups had their motor problems recognized at the same median age of 7 months, and both groups had comparable rates of severe brain injury on imaging. This suggests that the timing of diagnosis mainly reflects what prompted doctors to look for the injury (acute symptoms versus delayed developmental concerns), rather than reflecting actual differences in how severe or when the stroke occurred. In the large majority of cases (about 85%), no clear cause for the stroke could be identified.
This research matters because it helps clinicians and families understand that a late diagnosis of perinatal cerebral infarction does not necessarily mean the injury was milder or fundamentally different from those caught earlier. It also highlights that perinatal stroke often goes undetected in the newborn period, particularly when babies do not show acute symptoms. The findings underscore the ongoing challenge of identifying causes of perinatal stroke, which could be important for preventing recurrence and developing targeted treatments.
Ogoyama M, Takahashi H, Horie K, Suzuki H, Ohkuchi A, Fujiwara H. (2026). Diagnostic Course and Clinical Characteristics of Severe Cerebral Palsy Associated With Perinatal Cerebral Infarction: A Nationwide Registry-Based Study in Japan.. The journal of obstetrics and gynaecology research. https://doi.org/10.1111/jog.70491