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Published on: January 11, 2016
Neuropsychological problems after paediatric stroke: two year follow-up of Swiss children
J Pavlovic1, F Kaufmann, E Boltshauser
1University Children's Hospital Berne, Switzerland. julia.pavlovic@insel.ch
Insights
Pediatric stroke impacts children
Area of Science:
- Neurology
- Pediatrics
- Neuropsychology
Background:
- Paediatric ischaemic stroke affects children and neonates.
- Long-term neurological and cognitive outcomes require further investigation.
Purpose of the Study:
- To assess neurological and cognitive outcomes in children post-paediatric ischaemic stroke.
- To identify predictors of outcome in this population.
Main Methods:
- Retrospective analysis of data from the Swiss neuropaediatric stroke registry (SNPSR).
- Follow-up examinations including neurological and neuropsychological assessments at 18-24 months post-stroke.
- Inclusion of children (AIS 1) and neonates (AIS 2).
Main Results:
- 75% of children experienced neuropsychological problems, with reduced Performance IQ and affected processing speed/auditory short-term memory.
- School career effects were common; right-sided infarctions correlated with worse outcomes.
- Neonatal stroke survivors (7/11) showed normal development, but epilepsy predicted a worse prognosis.
Conclusions:
- Neuropsychological deficits are common after paediatric stroke.
- Younger age at stroke onset and epilepsy are predictors of poorer outcomes.
- Mid-childhood strokes had the best prognosis.
Aim:
The aim of this study was to obtain information about neurological and cognitive outcome for a population-based group of children after paediatric ischaemic stroke.
Methods:
Data from the Swiss neuropaediatric stroke registry (SNPSR), from 1.1.2000 to 1.7.2002, including children (AIS 1) and neonates (AIS 2). At 18-24 months after a stroke, a follow-up examination was performed including a history, neurological and neuropsychological assessment.
Results:
33/48 children (22 AIS 1, 11 AIS 2) participated in the study. Neurological outcome was good in 16/33. After childhood stroke mean IQ levels were normal (94), but 6 children had IQ < 85 (50-82) and neuropsychological problems were present in 75%. Performance IQ (93) was reduced compared to verbal IQ (101, p = 0.121) due to problems in the domain of processing speed (89.5); auditory short-term memory was especially affected. Effects on school career were common. Outcome was worse in children after right-sided infarction. Children suffering from stroke in mid-childhood had the best prognosis. There was no clear relationship between outcome and localisation of the lesion. After neonatal stroke 7/11 children showed normal development and epilepsy indicated a worse prognosis in the remaining 4.
Conclusion:
After paediatric stroke neuropsychological problems are present in about 75% of children. Younger age at stroke as well as an emergence of epilepsy were predictors for worse prognosis.
