Cognitive Functioning, Behavior, and Quality of Life After Stroke in Childhood

Abstract

Moderate cognitive and motor deficits, behavioral problems, and impairment in some aspects of quality of life frequently remain after stroke in childhood. Visuospatial functions are more often reduced than verbal functions, independent of the hemispheric side of lesion. This indicates a functional superiority of verbal skills compared to visuospatial skills in the process of recovery after brain injury. Compared to the cognitive outcome following stroke in adults, cognitive sequelae after childhood stroke do indicate neither the lateralization nor the location of the lesion focus. Age at stroke seems to be the only determining factor influencing cognitive outcome.

Factors affecting cognitive outcome in early pediatric stroke

“…Previous studies by our group 13,15 included 10 and 22 AIS children, respectively. Children were excluded from this analysis for the following reasons: death (n 5 12), did not report for follow-up (n 5 39), preexisting conditions that influence cognition such as trisomy 21 (n 5 6), and use of a test that was not part of the predefined assessment battery (n 5 3).…”

“…[7][8][9][10] However, younger age at stroke is associated with poorer intellectual outcome and a broader spectrum of dysfunctions across multiple neuropsychological domains. 6,[11][12][13][14][15][16][17] Further, children with combined cortical and subcortical lesions have overall poorer cognitive outcome, 16,18 and larger lesion size negatively influences cognitive and functional outcome, 4,19,20 possibly due to disruption of more neural network connections, adversely affecting functional brain organization. 21 Regarding lesion laterality, controversial reports exist concerning the effect of lesion laterality on neuropsychological outcome.…”

“…21 Regarding lesion laterality, controversial reports exist concerning the effect of lesion laterality on neuropsychological outcome. [11][12][13]15,16,22 In addition, persistent seizures 10,22 and persistent NI such as hemiplegia/paresis or visual field deficits also negatively influence neuropsychological and functional outcome. 5,11,19 The main goal of this study was to examine the influence of age, lesion characteristics, seizures, NI, and functional outcome on cognitive outcome in a population-based group of children 2 years after an AIS occurrence.…”

Antithrombotic Therapy in Neonates and Children

“…[700][701][702] Outcomes from childhood AIS include death in 3% to 5% and permanent cognitive or motor disability in 30% to 80%. 671,703,704 Survival rates are signifi cantly better than in adults, and children with stroke who do not die acutely will probably survive beyond middle age, and the treatment of the resulting comorbidity will be extremely expensive. The health burden of this disease entity is thus very large.…”

Cerebral White Matter Injuries Following a Hypoxic/Ischemic Insult During the Perinatal Period: Pathophysiology, Prognostic Factors, and Future Strategy of Treatment Approach. A Minireview

“…There is considerable evidence that an early brain insult is associated with a broad spectrum of neuropsychological dysfunction [57,58]. In fact, the onset of stroke at a younger age predisposes to an overall worse prognosis [59][60][61], weaker cognitive performance, and is subject to lesion location [62].…”