stroke congenital stroke true Stroke may occur prenatally or perinatally, with middle cerebral artery distribution stroke being common due to the nature of stroke etiologies in this age group. Infants may present with hemiplegia, which may only be diagnosed as development progresses and asymmetric motor function is recognized, such as early hand preference. Seizures may be the presenting symptom, and may have onset in the neonatal period or later. Because of the middle cerebral artery territory involvement, seizures with focal features that relate to sensori-motor cortex occur. Epileptic spasms occur in around one third of patients, generally responding to medication.