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Published on: February 2, 2015
Head circumference trajectory in children with perinatal stroke
Amanda Leong1, Amalia Floer1, Adam Kirton1,2
1Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.
Insights
Children with perinatal stroke experience slower head growth, which is linked to poorer developmental outcomes. Head circumference monitoring may help identify neurological risks early.
Area of Science:
- Pediatric Neurology
- Neurodevelopmental Disorders
- Medical Imaging
Background:
- Perinatal stroke is a primary cause of hemiparetic cerebral palsy and long-term disability.
- Predicting neurodevelopmental outcomes in affected children remains challenging.
- Head circumference deceleration is a known indicator of adverse outcomes in neonatal brain injury.
Purpose of the Study:
- To investigate if perinatal stroke leads to reduced head growth rates in children.
- To determine the association between head growth deceleration and neurodevelopmental outcomes.
Main Methods:
- Utilized data from the Alberta Perinatal Stroke Project cohort.
- Included patients with confirmed neonatal arterial ischemic stroke or presumed perinatal ischemic stroke.
- Analyzed occipital-frontal circumference data against control charts and correlated with Pediatric Stroke Outcome Measures (PSOM) scores.
Main Results:
- Head circumference measurements from 102 patients over a median of 3.2 years were analyzed.
- Occipital-frontal circumference deviated below normal growth trajectories after 3 months (females) and 1 year (males) (P < .05).
- Smaller head circumference was significantly associated with poor outcomes (PSOM ≥ 1) (P < .05).
Conclusions:
- Children with perinatal arterial ischemic stroke exhibit head growth deceleration.
- This deceleration is linked to adverse neurodevelopmental outcomes.
- Head circumference can serve as a potential clinical marker for neurological risk assessment.
Background:
Perinatal stroke is a leading cause of hemiparetic cerebral palsy and lifelong disability. Neurodevelopmental outcomes are difficult to predict and markers of long-term poor outcome continue to be investigated. Deceleration in growth of head circumference has been associated with worse developmental outcomes in neonatal brain injury. We hypothesized that perinatal stroke would result in decreased rates of head growth during childhood that would be associated with worse developmental outcomes.
Methods:
Patients with magnetic resonance imaging (MRI)-confirmed neonatal arterial ischemic stroke and arterial presumed perinatal ischemic stroke were identified from a population-based research cohort (Alberta Perinatal Stroke Project). Demographics and occipital-frontal circumference data were collected from medical records. Head growth was compared to typically developing control charts using a 2-tailed t test. The Fisher exact test was used to examine associations between Pediatric Stroke Outcome Measures (PSOM) scores and occipital-frontal head circumference.
Results:
Three hundred fifteen occipital-frontal head circumference measurements were collected from 102 patients (48 female, 54 male), over a median of 3.2 years (standard deviation = 5.18, range = 0-18.3). After 3 months for female patients and 1 year for male patients, occipital-frontal head circumference deviated and remained below normal growth trajectories (P < .05) with a large effect size (Cohen d >0.8). Poor outcome (PSOM ≥ 1) was associated with smaller occipital-frontal head circumference (P < .05).
Conclusion:
Head growth deceleration is observed in children with perinatal arterial ischemic stroke and is associated with poor outcome. Head circumference may be a tool to alert clinicians to the potential of abnormal neurologic outcome.
