Diagnostic Course and Clinical Characteristics of Severe Cerebral Palsy Associated With Perinatal Cerebral Infarction: A Nationwide Registry-Based Study in Japan.

AIM: To clarify the clinical characteristics, diagnostic course, and presumed etiologies of severe cerebral palsy associated with perinatal cerebral infarction, and to compare cases in which cerebral infarction was diagnosed during and after the neonatal period. METHODS: This retrospective registry-based study used data from the Japan Obstetric Compensation System for Cerebral Palsy between 2009 and 2022. Severe cerebral palsy cases associated with cerebral infarction were identified. The clinical characteristics and diagnostic courses of cerebral infarction were evaluated and compared between neonatally diagnosed cases and post-neonatally diagnosed cases. RESULTS: Of the 85 cases of cerebral infarction analyzed, neonatally diagnosed cases accounted for 40 (47.1%) and post-neonatally diagnosed cases for 44 (51.8%); 1 case was diagnosed prenatally. Neonatal diagnosis was more frequently triggered by seizures, apnea, respiratory distress, or neuroimaging during NICU hospitalization, whereas most post-neonatal diagnoses followed recognition of motor impairment. Neonatally diagnosed cases more frequently exhibited a non-reassuring fetal status, lower umbilical artery pH, lower Apgar scores, and neonatal asphyxia. However, no significant differences were observed in median age at the recognition of motor impairment (7 months in both groups) or severe brain injury findings between neonatally and post-neonatally diagnosed cases. Potential contributing conditions were identified in 15.3% of cases. CONCLUSIONS: Similar timing of motor impairment recognition and frequency of severe brain injury findings between the two groups may suggest that differences in cerebral infarction diagnostic timing may primarily reflect different clinical triggers for neuroimaging. The etiology and timing of infarction onset remained unclear in many cases.