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Perinatal stroke comprises a heterogeneous group of focal cerebrovascular injuries that occur between 20weeks of gestation and 28 days of postnatal life. Perinatal stroke is a leading cause of life-long disability, causing most cases of hemiparetic cerebral palsy. The intent of this article was to provide a comprehensive review of the 6 different types of perinatal stroke based on neuroimaging and clinical presentation, highlighting their similarities and distinctions in etiology and outcome, and further discuss a neuroimaging pathway for suspected perinatal stroke and follow-up imaging. Learning Objective: To provide an update on the current knowledge of the role of neuroimaging in diagnosis and long-term prognosis of perinatal stroke diseases and to understand the microglial role in perinatal arterial stroke. [ABSTRACT FROM AUTHOR]