A Review of Cognitive Outcomes in Children Following Perinatal Stroke

Abstract

Perinatal stroke is a significant cause of congenital neurological disability. Although motor deficits and epilepsy are relatively easy to identify, developmental and behavioral co-morbidities are more complex and challenging to define. We provide an overview of perinatal stroke syndromes and theories relating injury in the developing brain to long-term outcomes. We present a comprehensive overview of the effects on intelligence and other specific cognitive domains, as well as investigations relating clinical features and neuroimaging to deficits. Better understanding of the impact of early stroke has potential to elucidate processes of brain development, in addition to providing guidance for prognosis and rehabilitation.

Long-term neurodevelopmental outcome after perinatal arterial ischemic stroke and periventricular venous infarction

“…The barriers to the study of neuropsychological outcomes include the complexity of the timing of the appearance of specific deficits, the use of variable outcome measures, and studies with modest mixed samples that only rarely use a prospective longitudinal design. 4,30 We chose KeABCeII instead of the Wechsler Intelligence Scale for Children (WISC) because it allows a more valid assessment of children with suspected language impairment (with the possibility to interpret results by excluding verbal ability). 41 KeABCeII index scores have been found to correlate strongly with WISCeIV, 34,41 which makes the results of our study easily comparable to other studies.…”

“…Outcomes by pediatric stroke outcome measure (PSOM). Scoring criteria according to PSOM: Normal ¼ score 0 in all five subscales; Mild deficit ¼ score 0.5 in one subscale only; Moderate deficit ¼ score 0.5 in more than one subscale, or score 1 in one subscale, or score 1 in one subscale and 0.5 in another subscale; Severe deficit ¼ score 0.5 in all five subscales, or score 1 in one subscale plus 0.5 in two subscales, or score 1 or 2 in at least two subscales 30. …”

Manual dexterity, but not cerebral palsy, predicts cognitive functioning after neonatal stroke

“…2 Other studies have shown stability in cognitive scores, suggesting that the developing brain can buffer the effect of an early focal insult. 3 In most studies, the determinants of outcome have been primarily focused on presumably deleterious factors (lesion size or diagnosis of epilepsy, or a disorder of motor function like cerebral palsy [CP]), 1,4,5 but potentially protective factors have not been addressed. In addition, several studies have included various perinatal stroke syndromes where the timing, localization, and type of insults are diverse.…”

Neural activation within the prefrontal cortices during the goal-directed motor actions of children with hemiplegic cerebral palsy

“…This notion corroborates with a prior investigation that has suggested that children with HCP have deficits in cognitive processing. 52 This may indicate that the brain insults seen in children with HCP are not limited to sensorimotor areas only, but rather they have a cascading effect on the other cortical areas.…”