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Neuropsychological profile in pediatric patients with brain arteriovenous malformations
Adriane Oliveira Lima1, Daniela de Souza Coelho1, Raphael Wuo-Silva1
11Department of Neurology and Neurosurgery, Universidade Federal de São Paulo; and.
Insights
Pediatric brain arteriovenous malformations (bAVMs) frequently cause cognitive impairments in children, affecting memory and executive functions. Lesion location influences memory deficits, underscoring the need for thorough neuropsychological assessment.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Vascular Malformations
Background:
- Brain arteriovenous malformations (bAVMs) can lead to significant neurological and cognitive issues in pediatric patients, impacting development and quality of life.
- Cognitive deficits in children with bAVMs can occur even without hemorrhage, affecting neurodevelopment and social adaptation.
Purpose of the Study:
- To characterize the neuropsychological profile of pediatric patients diagnosed with bAVMs.
- To explore the relationship between cognitive performance and specific characteristics of the bAVMs.
Main Methods:
- A cross-sectional study involving 17 pediatric patients (6-17 years) with confirmed bAVMs.
- Neuropsychological assessments were conducted using standardized batteries, evaluating domains such as memory, attention, and executive functions.
- Results were compared against age- and education-adjusted normative data.
Main Results:
- Cognitive impairments were prevalent in 88.2% of patients, with deficits most commonly observed in working memory, general memory, arithmetic ability, and praxis.
- Patients with bAVMs in noneloquent areas showed poorer performance in memory tasks.
- No significant associations were found between cognitive deficits and Spetzler-Martin grade, venous pattern, lesion size, lobe, or hemisphere.
Conclusions:
- Cognitive impairments are common in pediatric patients with both ruptured and unruptured bAVMs, particularly affecting executive functions, memory, and arithmetic skills.
- The location of the bAVM, specifically its eloquence, is linked to memory domain performance.
- Comprehensive neuropsychological evaluations are crucial for treatment planning and long-term management of pediatric bAVM patients.
Objective:
Brain arteriovenous malformations (bAVMs) are vascular anomalies that can cause significant neurological and cognitive impairments in children and adolescents, even in the absence of hemorrhage. These symptoms, especially the cognitive deficits, can significantly interfere with neurodevelopment and affect social adaptation and quality of life. This study aimed to characterize the neuropsychological profile of pediatric patients with bAVMs and to investigate associations between cognitive performance and malformation characteristics.
Methods:
This cross-sectional study included children and adolescents (6-17 years of age) with a confirmed diagnosis of bAVM treated between 2016 and 2023 at the authors' institutions. All information was obtained from medical records. Neuropsychological assessment was performed using the Brief Neuropsychological Assessment Battery infant (6-12 years) and adult (> 12 years) versions. The evaluated domains included orientation, attention, working memory, verbal fluency, memory, language, praxis, perception, and arithmetic ability. Results were compared to age- and education-adjusted normative data.
Results:
Seventeen patients were included in the study (58.8% female, age range 6-16 years); 10 had ruptured and 7 had unruptured bAVMs. Cognitive impairments were observed in 15 patients (88.2%), most frequently affecting working memory (digit ordering) in 7 patients (41.2%), memory in 5 (29.4%), arithmetic ability in 5 (29.4%), and praxis in 4 (23.5%). In all other domains, at least 1 patient exhibited some degree of impairment. Lesions located in noneloquent areas were associated with lower result performance in the memory domain. No significant associations were found with Spetzler-Martin grade, venous pattern, lesion size, lobe localization, or hemisphere.
Conclusions:
Cognitive impairments were common in children and adolescents with both ruptured and unruptured bAVMs, with the most frequent deficits involving executive functions, memory, and arithmetic ability. Lesion location, according to eloquence, was associated with poorer performance in the memory domain. These findings highlight the importance of comprehensive neuropsychological evaluation for guiding treatment planning and ensuring effective long-term follow-up.
