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Updated: Oct 18, 2025
Measuring Post-Stroke Cerebral Edema, Infarct Zone and Blood-Brain Barrier Breakdown in a Single Set of Rodent Brain Samples
Published on: October 23, 2020
Cerebral blood flow and cognitive outcome after pediatric stroke in the middle cerebral artery
Leonie Steiner1, Andrea Federspiel2, Jasmine Jaros1
1Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Insights
Children with arterial ischemic stroke (AIS) show reduced cerebral blood flow (CBF) years later, impacting cognitive function. Higher interhemispheric perfusion imbalance in the middle cerebral artery (MCA) is linked to poorer working memory.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Cognitive Neuroscience
Background:
- Adaptive recovery of cerebral perfusion is vital for cognitive rehabilitation after pediatric stroke.
- Understanding chronic-stage cerebral blood flow (CBF) and its cognitive associations in pediatric arterial ischemic stroke (AIS) is crucial.
Purpose of the Study:
- To investigate CBF and cognitive functions in pediatric AIS patients in the chronic stage.
- To determine the association between CBF, particularly interhemispheric perfusion imbalance, and cognitive outcomes.
Main Methods:
- Cross-sectional study comparing 14 pediatric AIS patients (MCA territory) with 36 healthy controls.
- Cognitive functions assessed using neuropsychological tests.
- CBF measured via arterial spin labeled (ASL) imaging in anterior, middle, and posterior cerebral arteries (ACA, MCA, PCA).
Main Results:
- Pediatric AIS patients exhibited lower IQ scores and cognitive functions than controls.
- ASL imaging revealed significantly lower ipsilesional CBF in the MCA and PCA in patients.
- Patients showed higher interhemispheric perfusion imbalance in the MCA, associated with lower working memory.
Conclusions:
- Reduced ipsilesional CBF in MCA and PCA, and interhemispheric imbalance persist years after pediatric MCA stroke.
- Cerebral hypoperfusion and perfusion imbalance may contribute to long-term cognitive variability after pediatric stroke.
Abstract:
Adaptive recovery of cerebral perfusion after pediatric arterial ischemic stroke (AIS) is sought to be crucial for sustainable rehabilitation of cognitive functions. We therefore examined cerebral blood flow (CBF) in the chronic stage after stroke and its association with cognitive outcome in patients after pediatric AIS. This cross-sectional study investigated CBF and cognitive functions in 14 patients (age 13.5 ± 4.4 years) after pediatric AIS in the middle cerebral artery (time since AIS was at least 2 years prior to assessment) when compared with 36 healthy controls (aged 13.8 ± 4.3 years). Cognitive functions were assessed with neuropsychological tests, CBF was measured with arterial spin labeled imaging in the anterior, middle, and posterior cerebral artery (ACA, MCA, PCA). Patients had significantly lower IQ scores and poorer cognitive functions compared to healthy controls (p < 0.026) but mean performance was within the normal range in all cognitive domains. Arterial spin labeled imaging revealed significantly lower CBF in the ipsilesional MCA and PCA in patients compared to healthy controls. Further, we found significantly higher interhemispheric perfusion imbalance in the MCA in patients compared to controls. Higher interhemispheric perfusion imbalance in the MCA was significantly associated with lower working memory performance. Our findings revealed that even years after a pediatric stroke in the MCA, reduced ipsilesional cerebral blood flow occurs in the MCA and PCA and that interhemispheric imbalance is associated with cognitive performance. Thus, our data suggest that cerebral hypoperfusion might underlie some of the variability observed in long-term outcome after pediatric stroke.
