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Predictors of motor outcome after childhood arterial ischemic stroke

Emily Blackburn1, Felice D'arco2, Andrea Devito2

  • 1Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK.

Developmental Medicine and Child Neurology
|May 10, 2021
PubMed

Insights

Younger children and those with moyamoya disease face poorer long-term motor outcomes following childhood arterial ischemic stroke (AIS). Adult stroke prediction scores like ASPECTS are not effective in pediatric cases.

Area of Science:

  • Pediatric Neurology
  • Neurovascular Imaging
  • Stroke Medicine

Background:

  • Childhood arterial ischemic stroke (AIS) in the middle cerebral artery (MCA) territory presents unique challenges for predicting long-term motor outcomes.
  • Established adult stroke assessment tools, such as the Alberta Stroke Program Early Computed Tomography Score (ASPECTS), have shown limited utility in pediatric populations.
  • Accurate outcome prediction is crucial for guiding treatment decisions and managing expectations for affected children and their families.

Purpose of the Study:

  • To identify clinical and radiological predictors of long-term motor function after AIS in children affecting the MCA territory.
  • To evaluate the applicability of adult stroke scoring systems in predicting outcomes for pediatric AIS.
  • To inform risk-benefit analyses for potential hyperacute therapies in childhood AIS.

Main Methods:

  • Retrospective review of medical records for 69 children diagnosed with first-time MCA territory AIS.
  • Classification of cases using the Childhood AIS Standardized Classification and Diagnostic Evaluation (CASCADE) system.
  • Evaluation of magnetic resonance imaging (MRI) and angiography, including calculation of ASPECTS; motor outcome assessed via the Recurrence and Recovery Questionnaire.

Main Results:

  • No acute radiological predictors of eventual motor outcome were identified.
  • CASCADE 3A (moyamoya disease) and Wallerian degeneration were significantly associated with poor motor outcomes at follow-up.
  • Multivariate analysis revealed younger age at stroke onset and CASCADE 3A as independent predictors of poor long-term motor prognosis.

Conclusions:

  • Adult stroke prediction paradigms like ASPECTS are not effective for predicting outcomes in pediatric AIS.
  • Younger children with AIS tend to experience poorer long-term motor prognoses compared to older children.
  • Moyamoya disease is a significant indicator of poor motor outcome in childhood AIS, highlighting the need for specialized assessment tools.
Abstract

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