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Published on: November 21, 2013
Prognostic value of acute neuroimaging and clinical factors in pediatric post-pump chorea
Ming Liu1, Weixing Feng1, Xiaojuan Tian1
1Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China.
Insights
Pediatric post-pump chorea (PPC) is often linked to poor outcomes, with younger age and shorter symptom onset after surgery associated with better recovery. Neuroimaging and cyanotic heart disease are key indicators for risk stratification in PPC.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Cardiology
Background:
- Post-pump chorea (PPC) is a rare but serious neurological complication following cardiac surgery in children.
- Understanding the factors influencing PPC outcomes is crucial for early intervention and management.
Purpose of the Study:
- To investigate the relationship between early neuroimaging findings, clinical features, and long-term outcomes in pediatric PPC.
- To identify predictors of good versus poor neurological recovery in children with PPC.
Main Methods:
- A retrospective analysis of 26 pediatric PPC cases (2 institutional, 24 literature-derived).
- PPC defined as chorea onset within one month of cardiopulmonary bypass surgery.
- Outcomes classified as good (resolution ≤6 months), poor (>6 months persistence), or death.
- Comparison of clinical characteristics and acute-phase neuroimaging (CT/MRI) between outcome groups.
Main Results:
- Only 19.2% of patients achieved complete neurological recovery; 57.7% had persistent chorea, and 6 died.
- Older age at onset and longer surgery-to-chorea latency correlated with good outcomes.
- Cyanotic heart disease and acute neuroimaging abnormalities (basal ganglia/cortical lesions) were more frequent in the poor-outcome group.
Conclusions:
- Younger age at onset, shorter symptom latency, cyanotic heart disease, and specific neuroimaging findings predict persistent deficits in pediatric PPC.
- These factors may assist in early risk stratification for pediatric PPC patients.
- Limitations necessitate caution against causal inference, but findings guide clinical assessment.
Objective:
To evaluate the association between early postoperative neuroimaging findings, clinical characteristics, and long-term clinical outcomes in pediatric post-pump chorea (PPC).
Methods:
We conducted a retrospective, combined cohort study incorporating two institutional PPC cases and 24 literature-derived cases (total n = 26). PPC was defined as chorea onset within one month of cardiac surgery using cardiopulmonary bypass. Outcomes were categorized as good (resolution within 6 months), poor (persistence >6 months), or death. Clinical features and acute-phase neuroimaging (CT/MRI within one month of symptom onset) were compared between outcome groups.
Results:
Only five patients (19.2%) achieved complete neurological recovery. Persistent chorea occurred in 15 patients (57.7%), and six deaths were recorded. Older age at onset (10.1 ± 4.0 vs. 2.8 ± 4.3 years; P = 0.002) and longer surgery-to-chorea latency (11.4 ± 6.3 vs. 4.9 ± 3.3 days; P = 0.029) were associated with good outcomes. Cyanotic heart disease was more frequent in the poor-outcome group (100% (15/15) vs. 40.0% (2/5); χ2 = 10.6, P = 0.009). Acute-phase neuroimaging abnormalities were also more prevalent in the poor-outcome group (86.7% (13/15) vs. 20.0% (1/5); χ2 = 12.9, P = 0.048), with basal ganglia lesions (40.0%) and cortical involvement (predominantly atrophy/reduced volume, 46.7%).
Conclusion:
Younger age at onset, shorter symptom latency, the presence of cyanotic heart disease, and acute neuroimaging abnormalities involving the basal ganglia and cortex are associated with persistent neurological deficits in pediatric PPC and may aid in early risk stratification, although study limitations prevent causal inference.
