We lack knowledge of the developmental profiles of different brain injuries in hemiplegic cerebral palsy (HCP). This is important because children with specific injury patterns may respond differently to rehabilitation interventions. To assess the relative proportion of brain injury patterns in HCP and compare the developmental profile of children with middle cerebral artery (MCA) and periventricular venous infarctions (PVI). Children aged 2–18 years with a diagnosis of HCP were recruited from 9 children’s rehabilitation hospitals and informed consent was obtained. Developmental and neuroimaging information were collected from 6 sources: 1) data extraction from the health record, 2) brain imaging categorized by a neuroradiologist, 3) administration of the Quality of Upper Extremity Skills Test (QUEST) and classification of Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) by an occupational therapist, 4) child/parent questionnaires on hand usage: the Children’s Hand-use Experience Questionnaire (CHEQ) or Pediatric Upper Extremity Motor Activity Log (PMAL), 5) physician-administered sensory exam and 6) full scale intelligence quotient (IQ). Two groups comprising the most prevalent brain injury patterns were compared using a cross-sectional study design. Of 321 recruited, 246 (76.6%) had neuroimaging and were included in the analyses. The mean age was 8.30± 4.28, GMFCS I (n=181, 77.0%) and II (n=39, 16.6%), MACS I (n=82, 35.3%), II (n= 101, 43.5%). Neuroimaging revealed MCA infarctions (n=98, 39.8%), periventricular white matter lesions (n=110, 44.7%) of which periventricular venous infarction (PVI) was present in n=41, (16.7%), miscellaneous (n=8, 3.3%), unilateral malformations (n=19, 7.7%), non-MCA arterial infarctions (n=3, 1.2%), and normal imaging (n=8, 3.3%). Comparing PVI to MCA, the QUEST total score was higher in PVI, with 79.43±16.96 compared to 49.79±31.39 in MCA (t = 5.48, p value <0.001). Hand usage scores (PMAL/CHEQ) were higher in the PVI compared to the MCA group (X2 = 11.01, p< 0.004). Light touch sensation was better in the PVI compared to the MCA group (X2 = 5.3, p = 0.021). The full scale IQ score was higher in the PVI group (53.08±30.71) compared to the MCA group (27.34±28.29, t = 3.63, p = 0.001). Neuroimaging in HCP identified a high proportion of periventricular injuries, many of which were periventricular venous infarctions. The neurodevelopmental profile of children with PVI demonstrated higher hand function and hand usage, increased light touch and higher IQs compared to the MCA group. This study aids in defining rehabilitation needs in HCP informed by brain injury patterns.