Cerebellar Atrophy in Childhood Arterial Ischemic Stroke

Abstract

Such early outcome predictors may inform stroke recoveryBackground and Purpose-Crossed cerebellar atrophy is uncommon in childhood arterial ischemic stroke. Acute corticospinal tract diffusion-weighted imaging (CST-DWI) changes occur in stroke of all ages. Contralateral CST-DWI is unexplained but approximates corticopontocerebellar pathways. We hypothesized that cerebellar atrophy can be quantified on clinical neuroimaging in childhood arterial ischemic stroke and is predicted by contralesional CST-DWI. Methods-Consecutive children (>28 days-18 years) were included with the following features: (1) acute, unilateral, middle cerebral artery arterial ischemic stroke, (2) DWI <14 days from stroke onset, (3) anatomic T1 MRI >6 months, and (4) Pediatric Stroke Outcome Measure >12 months. Blinded scorers measured cerebellar volumes (left/right/hemisphere/ vermis/total) using Osirix software. Cerebellar volumes ratios (nonstroke/stroke) were expressed as asymmetry indices (AI), with chronic/acute ratio <1.0 suggesting crossed atrophy. Acute brain stem and cerebellum (peduncle, hemisphere) DWI ratios were scored. Software measures were compared with visual inspection. Associations between AI, motor outcome (good/poor), and contralesional CST-DWI were sought. Rater reliabilities were assessed. Results-Twenty-three children were studied (median age, 6.3±4.4 years; 62% male). Baseline cerebellar volumes were comparable (right=56.9 cm 3 , left=57.1 cm

O impacto do acidente vascular cerebral na qualidade de vida de crianças e adolescentes

“…The results are in accordance with the reference data, showing children with CVA of the ischemic type 22 . Other findings that also corroborate with the literature refer to the main vascular territory (the middle cerebral artery is the artery which is more prone to injury due to its anatomy and thinner walls) 23 , the age at which children presented the time of the CVA (>29 days of life) 24 , and hemiparesis 25 .…”

Changes in structure and perfusion of grey matter tissues during recovery from Ischaemic subcortical stroke: a longitudinal MRI study

“…However, the mechanism for GM atrophy in ipsilesional cerebellar cortex cannot be explained by axonal degeneration through crossed fibres as all lesions located at the same side as cerebellum. We speculated that depression of metabolism at the non‐ischaemic side of hemisphere may result in GM atrophy in the ischaemic side of cerebellum, which was similar to the phenomenon of crossed cerebellar diaschisis (Mah et al ., ; Sommer et al ., ). Further investigation is still required to verify this speculation.…”

Thalamic diaschisis following perinatal stroke is associated with clinical disability

“…While acute diaschisis may involve changes in blood flow or metabolism, chronic diaschisis mechanisms are largely unknown (De Reuck et al, 1995; Lin et al, 2009). Contralesional or “crossed” cerebellar atrophy following supratentorial infarction is well described in adults and recently demonstrated in pediatric stroke (Baron et al, 1981; Chakravarty, 2002; Craig et al, 2018; De Reuck et al, 1995; Infeld et al, 1995; Kim et al, 1997; Lin et al, 2009; Mah et al, 2013).…”