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Transient Middle Cerebral Artery Occlusion Model of Neonatal Stroke in P10 Rats
Published on: April 21, 2017
Factors associated with six-month outcome of pediatric stroke
Anne L Gordon1,2,3, Vicki Anderson1,4,5,6, Michael Ditchfield7,8
1Clinical Sciences Theme, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.
Insights
Pediatric arterial ischemic stroke primarily causes sensorimotor impairments in older children, with no significant cognitive or language issues identified. Long-term follow-up is crucial for assessing outcomes and rehabilitation needs, especially in infants.
Area of Science:
- Pediatric neurology
- Neuroscience
- Clinical outcomes research
Background:
- Pediatric stroke outcome studies often use cross-sectional designs, limiting prospective data on clinical courses.
- Prospective information on the clinical course following pediatric arterial ischemic stroke (AIS) diagnosis is lacking.
- Understanding the long-term clinical course can inform management beyond the acute phase.
Purpose of the Study:
- To prospectively describe the one-month and six-month outcomes of pediatric arterial ischemic stroke (AIS) across various health domains.
- To investigate the relationship between lesion characteristics and early outcomes.
- To explore the association between early outcomes and six-month adaptive behavior.
Main Methods:
- A single-center, prospective, longitudinal study was conducted at a tertiary children's hospital from December 2007 to January 2012.
- Participants included children aged 0-18 years with a first-time diagnosis of AIS.
- Brain imaging characterized lesions, and children were analyzed in age groups: neonates versus those older than 30 days.
Main Results:
- Fifty children with a median age of 47 months at diagnosis were studied.
- Sensorimotor impairments were prominent acutely, particularly in older children.
- Significant motor impairments persisted at one and six months in older children; no significant cognitive or language deficits were found. Lesion characteristics did not predict six-month adaptive behavior.
Conclusions:
- Sensorimotor impairments are the primary clinical consequences of pediatric arterial ischemic stroke (AIS) survivors, evident acutely and at six months, especially in older children.
- Cognitive or language sequelae were not identified in this cohort.
- Long-term surveillance is essential to characterize the clinical course and rehabilitation needs, particularly for neonates and infants.
Background:
Pediatric stroke outcome studies are often cross sectional in design. Prospective information regarding the clinical course following diagnosis is lacking, but may inform clinical management beyond the acute period.
Aims:
To describe the outcome of arterial ischemic stroke in infants, children and adolescents at one-month and six-months post-stroke across health domains, and explore the relationship between lesion characteristics and early outcome with six-month adaptive behavior.
Methods:
A single center prospective longitudinal study at a tertiary level children's hospital. Recruitment was undertaken from December 2007 to January 2012. Participants were children aged birth to 18 years presenting acutely with first diagnosed arterial ischemic stroke. Lesion characteristics on brain imaging were classified. Children were grouped according to age at diagnosis for analysis (neonates vs. those aged >30 days).
Results:
In 50 children with a median age of 47 months at diagnosis, sensorimotor impairments were most evident upon neurological examination acutely, especially in the older children. At both one-month and six-months motor functioning was significantly impaired in the older age group but no significant cognitive or language sequelae were identified. Lesion characteristics alone were not associated with six-month adaptive behavior outcomes.
Conclusions:
For patients surviving arterial ischemic stroke, the most significant clinical consequences both acutely and at six-months, are sensorimotor impairments, particularly evident in the older children. In contrast cognitive or language sequelae were not identified. Long-term surveillance is required to describe clinical course and rehabilitation needs, particularly for neonates and infants.
