Large bilateral strokes in adults are often fatal and typically lead to severe functional impairment with little potential for recovery.1 By contrast, perinatal strokes are associated with variable functional outcomes, with as many as 25% of survivors having healthy motor and cognitive function.2 Focal cortical injuries sustained in early childhood can be compensated for more quickly and more completely than those sustained later in life.3 However, the mechanisms underlying cortical plasticity are only beginning to be understood.4 We have done an exhaustive investigation of one of our patients (PS1; an adolescent male), who sustained large, bilateral perinatal strokes in 1999, but nevertheless had typical neurodevelopment and his injuries went unnoticed until he was 13 years old. The case of this patient underscores the challenge of an accurate prognosis in children after early-life cortical injury.
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