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

Lõo, Silva; Ilves, Pilvi; Männamaa, Mairi; Laugesaar, Rael; Loorits, Dagmar; Tomberg, Tiiu; Kolk, Anneli; Talvik, Inga; Talvik, Tiina; Haataja, Leena

doi:10.1016/j.ejpn.2018.07.005

Cited by 24 publications

(39 citation statements)

References 47 publications

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“…In children with PVI, a study of intellectual development in 62 children found 76% to have typical development or mild intellectual disability, 23% with moderate intellectual disability, and one child with a severe intellectual disability 122 . Another study of 18 children with PVI found lower average IQ scores but no cases with extremely low cognitive ability 123 . Application of formal neuropsychological evaluations in a school‐aged cohort of children with fetal GMH‐IVH would be required to better characterize these outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Antenatal diagnosis of fetal intraventricular hemorrhage: systematic review and meta‐analysis

Dunbar

Woodward

Leijser

et al. 2020

Develop Med Child Neuro

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AIM To determine how the severity of antenatally diagnosed germinal matrix-intraventricular hemorrhage (GMH-IVH) relates to morbidity and mortality, and to explore potential risk factors. METHOD We conducted a systematic review and individual patient data meta-analysis of antenatally diagnosed fetal GMH-IVH. The primary outcomes were mortality and morbidity. Potential associations with clinical factors during pregnancy were explored. Analysis employed Fisher's exact test and logistic regression. RESULTS We included 240 cases from 80 studies. Presence of venous infarction was associated with mortality (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.4-13.25), motor impairment (OR 103.2, 95% CI 8.6-1238), epilepsy (OR 6.46, 95% CI 2.64-16.06), and developmental delay (OR 8.55, 95% CI 2.12-48.79). Shunt placement was associated with gestational age at GMH-IVH diagnosis and in utero progression. Many cases had uncomplicated pregnancies but possible co-occurring conditions included twin gestation, small for gestational age, and congenital anomalies. INTERPRETATION Severity of fetal GMH-IVH, specifically venous infarction, is associated with overall mortality and morbidity. Risk factors for fetal GMH-IVH are poorly understood and controlled studies are required.

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Section: Discussionmentioning

confidence: 99%

“…122 Another study of 18 children with PVI found lower average IQ scores but no cases with extremely low cognitive ability. 123 Application of formal neuropsychological evaluations in a school-aged cohort of children with fetal GMH-IVH would be required to better characterize these outcomes.…”

Section: Discussionmentioning

confidence: 99%

Antenatal diagnosis of fetal intraventricular hemorrhage: systematic review and meta‐analysis

Dunbar

Woodward

Leijser

et al. 2020

Develop Med Child Neuro

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“…In addition, for non-verbal functions in patients with leftsided lesions, language reorganization has been proposed as a modifying factor (6,7,14). This has been explained in the context of the "crowding hypothesis" (15)(16)(17), suggesting that cognitive processes originally located in the right hemisphere such as nonverbal intelligence show deficits when language functions shift to the right hemisphere.…”

Section: Introductionmentioning

confidence: 99%

“…It affects mostly term-born newborns, and presents with diverse signs and symptoms ( 2 ). Outcome is quite variable, with many children achieving normal levels of function ( 3 , 4 ), while others experience difficulties, such as impairment in different domains of cognitive functions ( 5 – 7 ) as well as in motor skills ( 8 – 10 ). Potentially modifying factors explaining the variability in cognitive outcome are lesion size, the severity of hand motor impairment ( 6 ), and the side of the lesion ( 11 – 13 ).…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, patients with perinatal stroke have a significant risk to develop epilepsy, which was estimated between 15% ( 18 ) and 54% ( 19 ). Not surprisingly, the type of the lesion also plays an important role, since children with cortico-subcortical lesions (commonly due to arterial ischemic strokes, AIS), are much more prone to develop epilepsies than children with white matter lesions (usually due to periventricular venous infarctions, PVI) ( 7 , 20 ). In addition to the burden of seizures and side effects of anti-epileptic medication, epilepsy may also hamper cognitive development.…”

Section: Introductionmentioning

confidence: 99%

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Non-verbal Intelligence in Unilateral Perinatal Stroke Patients With and Without Epilepsies

et al. 2021

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Background: The risk factors for impaired cognitive development after unilateral perinatal stroke are poorly understood. Non-verbal intelligence seems to be at particular risk, since language can shift to the right hemisphere and may thereby reduce the capacity of the right hemisphere for its originary functions. Pharmaco-refractory epilepsies, a frequent complication of perinatal strokes, often lead to impaired intelligence. Yet, the role of well-controlled epilepsies is less well-understood. Here, we investigated whether well-controlled epilepsies, motor impairment, lesion size, lesion side, and lateralization of language functions influence non-verbal functions.Methods: We recruited 8 patients with well-controlled epilepsies (9–26 years), 15 patients without epilepsies (8–23 years), and 23 healthy controls (8–27 years). All underwent the Test of Non-verbal Intelligence, a motor-independent test, which excludes biased results due to motor impairment. Language lateralization was determined with functional MRI, lesion size with MRI-based volumetry, and hand motor impairment with the Jebson-Taylor Hand Function-Test.Results: Patients with epilepsies showed significantly impaired non-verbal intelligence [Md = 89.5, interquartile range (IQR) = 13.5] compared with controls (Md = 103, IQR = 17). In contrast, patients without epilepsies (Md = 97, IQR = 15.0) performed within the range of typically developing children. A multiple regression analysis revealed only epilepsy as a significant risk factor for impaired non-verbal functions.Conclusion: In patients with unilateral perinatal strokes without epilepsies, the neuroplastic potential of one healthy hemisphere is able to support the development of normal non-verbal cognitive abilities, regardless of lesion size, lesion side, or language lateralization. In contrast, epilepsy substantially reduces this neuroplastic potential; even seizure-free patients exhibit below-average non-verbal cognitive functions.

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Frontal interhemispheric structural connectivity, attention, and executive function in children with perinatal stroke

et al. 2021

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Perinatal stroke affects ∼1 in 1000 births and concomitant cognitive impairments are common but poorly understood. Rates of Attention Deficit/Hyperactivity Disorder (ADHD) are increased 5-10× and executive dysfunction can be disabling. We used diffusion imaging to investigate whether stroke-related differences in frontal white matter (WM) relate to cognitive impairments. Anterior forceps were isolated using tractography and sampled along the tract. Resulting metrics quantified frontal WM microstructure. Associations between WM metrics and parent ratings of ADHD symptoms (ADHD-5 rating scale) and executive functioning (Behavior Rating Inventory of Executive Function (BRIEF)) were explored. Eighty-three children were recruited (arterial ischemic stroke [AIS] n = 26; periventricular venous infarction [PVI] n = 26; controls n = 31). WM metrics were altered for stroke groups compared to controls.Along-tract analyses showed differences in WM metrics in areas approximating the lesion as well as more remote differences at midline and in the nonlesioned hemisphere. WM metrics correlated with parental ratings of ADHD and executive function such that higher diffusivity values were associated with poorer function. These findings suggest that underlying microstructure of frontal white matter quantified via tractography may provide a relevant biomarker associated with cognition and behavior in children with perinatal stroke.

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

Cited by 24 publications

References 47 publications

Antenatal diagnosis of fetal intraventricular hemorrhage: systematic review and meta‐analysis

Antenatal diagnosis of fetal intraventricular hemorrhage: systematic review and meta‐analysis

Non-verbal Intelligence in Unilateral Perinatal Stroke Patients With and Without Epilepsies

Frontal interhemispheric structural connectivity, attention, and executive function in children with perinatal stroke

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