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Published on: April 21, 2017
Stroke in the Developing Brain: Neurophysiologic Implications of Stroke Timing, Location, and Comorbid Factors
Nayo M Hill1, Laura A Malone2, Lisa R Sun3
1Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Pediatric stroke impacts a developing brain, leading to long-term disability. Understanding stroke timing, location, and comorbidities is crucial for effective clinical care and improving outcomes in children.
Area of Science:
- Neurology
- Pediatrics
- Neuroscience
Background:
- Pediatric stroke is a unique brain injury in a developing brain, often causing lasting neurological deficits.
- Neuroplasticity in children affects recovery, with outcomes influenced by stroke timing, location, and co-occurring conditions.
Purpose of the Study:
- To review the implications of stroke across fetal, perinatal, and childhood/adolescent periods.
- To analyze the impact of brain developmental stage on motor, sensory, cognitive, speech, and behavioral outcomes.
- To examine stroke location effects and the influence of associated conditions on long-term results and recurrence risk.
Main Methods:
- Review of existing literature on pediatric stroke.
- Analysis of factors influencing neurodevelopmental outcomes.
- Discussion of comorbid conditions and their impact on stroke patients.
Main Results:
- Hemiparesis is frequent, with varying severity by age group.
- Epilepsy risk is elevated across all pediatric stroke age groups.
- Cognitive outcomes may be worse with early childhood strokes; associated conditions increase risks for delay and impairment.
Conclusions:
- A thorough understanding of interacting factors is vital for managing pediatric stroke patients.
- Tailored clinical care strategies are essential for optimizing recovery and minimizing long-term disability.
Background:
Pediatric stroke, which is unique in that it represents a static insult to a developing brain, often leads to long-term neurological disability. Neuroplasticity in infants and children influences neurophysiologic recovery patterns after stroke; therefore outcomes depend on several factors including the timing and location of stroke and the presence of comorbid conditions.
Methods:
In this review, we discuss the unique implications of stroke occurring in the fetal, perinatal, and childhood/adolescent time periods. First, we highlight the impact of the developmental stage of the brain at the time of insult on the motor, sensory, cognitive, speech, and behavioral domains. Next, we consider the influence of location of stroke on the presence and severity of motor and nonmotor outcomes. Finally, we discuss the impact of associated conditions on long-term outcomes and risk for stroke recurrence.
Results:
Hemiparesis is common after stroke at any age, although the severity of impairment differs by age group. Risk of epilepsy is elevated in all age groups compared with those without stroke. Outcomes in other domains vary by age, although several studies suggest worse cognitive outcomes when stroke occurs in early childhood compared with fetal and later childhood epochs. Conditions such as congenital heart disease, sickle cell disease, and moyamoya increase the risk of stroke and leave patients differentially vulnerable to neurodevelopmental delay, stroke recurrence, silent infarcts, and cognitive impairment.
Conclusions:
A comprehensive understanding of the interplay of various factors is essential in guiding the clinical care of patients with pediatric stroke.
