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Lesion volume, lesion location, and outcome after middle cerebral artery territory stroke
1Neurosciences Unit, Institute of Child Health, Guilford St, London WC1N 3JH, UK. v.ganesan@umds.ac.uk
Insights
In children with middle cerebral artery (MCA) territory infarcts, large lesion volumes (>10% of intracranial volume) predict poor outcomes. Small infarcts have variable results, highlighting the need for precise lesion characterization in stroke trials.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Stroke Research
Background:
- Middle cerebral artery (MCA) territory infarcts are a significant cause of stroke in children.
- Understanding the relationship between infarct characteristics and clinical outcomes is crucial for effective management.
Purpose of the Study:
- To investigate the association between lesion volume, lesion location, and clinical outcome in pediatric MCA territory infarcts.
Main Methods:
- Retrospective analysis of children with MCA territory infarcts.
- Lesion volume quantified as a percentage of intracranial volume (small, moderate, large).
- Lesion location categorized as cortical or subcortical; outcomes assessed via parental questionnaire (good/poor).
Main Results:
- 38 children identified (median age 6 years); 21 had cortical involvement.
- Poor outcomes observed in 26 cases, good outcomes in 12.
- Infarction >10% of intracranial volume universally led to poor outcomes; some small subcortical lesions caused significant deficits.
Conclusions:
- While outcomes for small MCA infarcts are unpredictable, large infarcts (>10% intracranial volume) consistently result in poor outcomes.
- Assessing lesion volume and location aids in identifying children for acute stroke treatment trials.
Aim:
To investigate the relation between lesion volume, lesion location, and clinical outcome in children with infarction in the territory of the middle cerebral artery (MCA).
Patients And Methods:
Children with MCA territory infarcts were selected retrospectively from a database of children with ischaemic stroke. Lesion volumes were expressed as a percentage of the supratentorial intracranial volume and were categorised as "small", "moderate", or "large". Lesion location was categorised as cortical or purely subcortical. Outcome was ascertained by parental questionnaire and was categorised as "good" or "poor".
Results:
38 patients were identified (median age 6 years); 21 patients had lesions that involved cortical tissue. Outcome was good in 12 cases and poor in 26 cases (including 2 children who died). Although there was no significant effect of lesion size or lesion location on outcome for the group as a whole, all children who had infarcted more than 10% of intracranial volume had a poor outcome. Of note, some children with small subcortical lesions had pronounced residual deficits.
Conclusions:
Although the outcome after a small infarct in the MCA territory is variable and unpredictable, infarction of more than 10% of intracranial volume is universally associated with a poor outcome. Characterisation of lesion volume and topography might be helpful in identification of such children for participation in future trials of treatments for acute stroke.