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Cognitive and Academic Outcomes Following Childhood Cortical Stroke
Rachel K Peterson1, Tricia S Williams1, Kyla P McDonald1
1Division of Neurology, Department of Pediatrics, Faculty of Medicine, Children's Stroke Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Children with childhood arterial ischemic stroke show resilience but have lower processing speed and fine motor skills. Maternal education and age at stroke impact cognitive outcomes, with lesion location influencing performance.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Cognitive Psychology
Background:
- Pediatric stroke research predominantly focuses on perinatal stroke, leaving childhood-onset stroke understudied.
- Limited understanding exists regarding the neurocognitive sequelae of childhood arterial ischemic stroke.
- This gap necessitates research into cognitive outcomes following stroke in children and youth.
Purpose of the Study:
- To examine cognitive outcomes in pediatric patients with cortical arterial ischemic stroke.
- To identify factors influencing neurocognitive performance in this population.
- To understand the relationship between lesion characteristics and cognitive deficits.
Main Methods:
- Retrospective study of 27 children and youth with childhood arterial ischemic stroke (cortical).
- Assessment of intellectual, academic, language, visual-perceptual, visual-motor, fine motor, and executive function skills.
- Exploratory analysis of personal (age at stroke/assessment, maternal education) and neurological factors (lesion characteristics).
Main Results:
- Children performed well in general intellectual ability but showed deficits in processing speed and fine motor coordination.
- Age at stroke correlated positively with perceptual reasoning and fine motor control.
- Maternal education positively influenced working memory and behavioral regulation; lesion location (right-sided, frontal) associated with poorer outcomes.
Conclusions:
- The developing brain demonstrates resilience following childhood arterial ischemic stroke.
- Specific cognitive functions, particularly processing speed and fine motor skills, remain vulnerable.
- Factors like age at stroke, maternal education, and lesion characteristics play a role in cognitive outcomes.
Abstract:
The majority of pediatric neuropsychological stroke research has focused on perinatal stroke outcomes given its relative frequency. Meanwhile, childhood-onset stroke is under-represented in the literature, resulting in limited knowledge about its neurocognitive sequelae. This retrospective study examined cognitive outcomes in children and youth (n = 27) with childhood arterial ischemic stroke (stroke occurring between 29 days and 18 years of life) isolated to the cortical region. Intellectual, academic, language, visual-perception, visual-motor integration, fine motor coordination, and executive function scores were examined relative to normative means. Results indicate that although these children are doing well in terms of general intellectual ability, they demonstrate lower scores on tasks of processing speed and fine motor coordination. Exploratory analysis also revealed that of the personal and neurologic factors examined, age at stroke was positively correlated with perceptual reasoning and fine motor control, age at assessment was negatively correlated with math calculation abilities, and maternal education was positively correlated with working memory and parent-reported behavioral regulation and impulse inhibition abilities. While neurologic variables were not predictive of cognitive neuropsychological outcomes, those with significant poorer performance had higher rates of medium/large, right-sided lesions with frontal lobe involvement. Our results highlight the overall resilience of the injured developing brain but also the vulnerability of specific cognitive skills within this unique population.
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