Exploring New Territories in Perinatal Stroke: Brain development, functional impact & neuroregenerative therapies

Around 1 in 5000 newborns experience a stroke around birth, known as a perinatal arterial ischemic stroke (PAIS). In PAIS, a blood vessel in the brain becomes blocked, leading to temporary oxygen deprivation and potential lasting brain damage. The consequences can be lifelong and consist of difficulties with movement, learning, language, behaviour, or memory. These difficulties can substantially impact the child’s and family’s daily life.

This thesis had three main aims: (1) to investigate how PAIS affects early brain development, (2) to assess long-term functioning of children with PAIS, and (3) to evaluate the safety and feasibility of a novel stem cell therapy in clinical practice.

In part one, we found that MRI scans of the brain combined with early motor assessments can reasonably predict which children will later develop motor impairments. Predicting cognitive or behavioural outcomes proved much more complex. In part two, children aged eight and older and their parents completed questionnaires. Over 75% reported daily challenges, including difficulties with movement, learning, and concentration—even in children without a prior diagnosis. A follow-up study showed that one-third scored below average on IQ, memory, or executive function tests, and over half reported fatigue or a reduced quality of life. In part three, stem cells were administered via nose droplets to newborns with PAIS. This treatment proved safe and feasible. No adverse effects were observed up to two years, and treated children showed better motor outcomes compared to untreated peers.

This thesis underscores the need for early detection and long-term support, and the promise of regenerative therapies to improve outcomes for children affected by PAIS.