HRQOLHealth RESULTS Significant risk factors at presentation for a poor neurological outcome were young age, infarction in the right middle cerebral artery territory, and fever at presentation. Fifty-four % of children had severe neurological impairments at 12 months after PAIS, and at last follow-up more than half needed remedial teaching, special education, or institutionalization. Health-related quality of life (HRQOL) questionnaires showed a significantly lower HRQOL in all age groups. Children with a longer follow-up had a lower HRQOL in the cognitive functioning domain.INTERPRETATION Our study shows significant morbidity and mortality and a reduced HRQOL after PAIS depending on age, fever at presentation, and infarction in the right middle cerebral artery territory.Paediatric arterial ischaemic stroke (PAIS) is relatively rare, with an estimated incidence of 3 to 8 per 100 000 for children older than 1 month. 1 Many risk factors leading to PAIS have been identified. 1-3 The long-term outcome in children with PAIS is frequently poor, and a wide spectrum of impairments influencing physical and cognitive abilities as well as quality of life (QOL) has been reported. [4][5][6] Most studies focus on neurological impairments after PAIS, 7 and only a few studies have systematically addressed functional outcome. 4,[6][7][8] According to the World Health Organization's International Classification of Impairments, Disabilities and Handicaps, in clinical research functional outcome can be assessed on the following levels: disease process and impairment (the general effect of the disease on the child), disability (the restriction of the ability to perform tasks within the physical and social environment), handicap (the social consequences of these impairments and disabilities in the domains of relationships, school, and leisure activities), and QOL (the sense of the child's well-being and life satisfaction in physical, social, and emotional domains). 9 The first two levels are physician-oriented outcomes, whereas those at the third and fourth levels consist mainly of patient-based outcomes. The fourth level also contains information from the patient's or parent's perspective. Neurological impairments after PAIS may affect up to 90% of children and include hemiparesis, epilepsy, visual deficits, and language, educational, cognitive, and behavioural problems. 7,10-14 The percentage of disabilities after PAIS can be as high as 60%. 14 Most restrictions are found in the domains of education, motor function, self-care skills, communication, and socialisation. 8,12 When measured on the modified Rankin Scale (mRS), 12 ⁄ 100 of children have no disability, 63% have mild disabilities, and 25 ⁄ 100 have severe disabilities. 7,15 Handicaps in children with childhood stroke include a necessity for higher levels of educational support and special education, psychiatric symptoms and disorders, sleeping problems, fatigue, emotional lability, and aggressive outbursts and social problems. 7,11,12,16 The QOL in this patient group is sig...