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Approximately one-quarter of childhood strokes occur in the perinatal period, which includes both fetuses and neonates, affecting between one in 2300–5000 births and representing the primary cause of cerebral palsy. Although the pathogenesis is incompletely understood, risk factors for perinatal stroke are often unique from strokes at other ages, with a combination of maternal, obstetric, anatomic, and genetic factors or predispositions leading to infarct. Clinical presentations of perinatal stroke differ from strokes in older children and adults, often presenting as encephalopathy, seizure, altered mental status, or neurologic deficits. However, neuroimaging remains equally indispensable for diagnosis and prognostication. Here, we provide a comprehensive review of perinatal strokes occurring in fetal and neonatal periods, and discuss the etiologies, diagnosis, management, and prognosis, with a focus on neuroimaging utilization and findings. Understanding the appropriate use of imaging in the distinct clinical entity of perinatal stroke is important for guiding appropriate clinical management.
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