Download PDF
Neuropediatrics 2006; 37(1): 13-19
DOI: 10.1055/s-2006-923932
Original Article

Georg Thieme Verlag KG Stuttgart · New York

Neuropsychological Problems after Paediatric Stroke: Two Year Follow-Up of Swiss Children

J. Pavlovic1 , F. Kaufmann1 , E. Boltshauser5 , A. Capone Mori6 , D. Gubser Mercati10 , C.-A. Haenggeli3 , E. Keller8 , J. Lütschg2 , J.-P. Marcoz12 , G.-P. Ramelli7 , E. Roulet Perez4 , T. Schmitt-Mechelke9 , M. Weissert11 , M. Steinlin1
  • 1University Children's Hospital Berne, Switzerland
  • 2University Children's Hospital Bale, Switzerland
  • 3University Children's Hospital Geneva, Switzerland
  • 4University Children's Hospital Lausanne, Switzerland
  • 5University Children's Hospital Zürich, Switzerland
  • 6Children's Hospital Aarau, Switzerland
  • 7Children's Hospital Bellinzona, Switzerland
  • 8Children's Hospital Chur, Switzerland
  • 9Children's Hospital Lucerne, Switzerland
  • 10Children's Hospital Neuchatel, Switzerland
  • 11Children's Hospital St. Gallen, Switzerland
  • 12Children's Hospital Sion, Switzerland
Further Information

Publication History

Received: September 6, 2005

Accepted after Revision: January 25, 2006

Publication Date:
15 March 2006 (online)

    Permissions and Reprints

Abstract

Aim: The aim of this study was to obtain information about neurological and cognitive outcome for a population-based group of children after paediatric ischaemic stroke. Methods: Data from the Swiss neuropaediatric stroke registry (SNPSR), from 1. 1. 2000 to 1. 7. 2002, including children (AIS 1) and neonates (AIS 2). At 18 - 24 months after a stroke, a follow-up examination was performed including a history, neurological and neuropsychological assessment. Results: 33/48 children (22 AIS 1, 11 AIS 2) participated in the study. Neurological outcome was good in 16/33. After childhood stroke mean IQ levels were normal (94), but 6 children had IQ < 85 (50 - 82) and neuropsychological problems were present in 75 %. Performance IQ (93) was reduced compared to verbal IQ (101, p = 0.121) due to problems in the domain of processing speed (89.5); auditory short-term memory was especially affected. Effects on school career were common. Outcome was worse in children after right-sided infarction. Children suffering from stroke in mid-childhood had the best prognosis. There was no clear relationship between outcome and localisation of the lesion. After neonatal stroke 7/11 children showed normal development and epilepsy indicated a worse prognosis in the remaining 4. Conclusion: After paediatric stroke neuropsychological problems are present in about 75 % of children. Younger age at stroke as well as an emergence of epilepsy were predictors for worse prognosis.

Key words

Paediatric stroke - cognitive outcome

References

  • 1 Aram D M, Eisele J A. Intellectual stability in children with unilateral brain lesions.  Neuropsychologia. 1994;  32 85-95
    CrossrefPubMedGoogle Scholar
  • 2 Banich M T, Levine S C, Kim H, Huttenlocher P. The effects of developmental factors on IQ in hemiplegic children.  Neuropsychologia. 1990;  28 35-47
    CrossrefPubMedGoogle Scholar
  • 3 Bayley N. Bayley Scale For Infant Development (BSID‐II), 2nd ed. San Antonio, TX; The Psychological Corporation 1993: 872-1726
    Google Scholar
  • 4 Chapman S B, Max J E, Gamino J F, McGlothlin J H, Cliff S N. Discourse plasticity in children after stroke: age at injury and lesion effects.  Pediatr Neurol. 2003;  29 34-41
    CrossrefPubMedGoogle Scholar
  • 5 De Schryver E LLM, Kappelle L J, Jennekens-Schinkel A, Peters B A. Prognosis of ischemic stroke in childhood: A long-term follow-up study.  Dev Med Child Neurol. 2000;  42 313-318
    CrossrefPubMedGoogle Scholar
  • 6 De Veber G, MacGregor D, Curtis R, Mayank S. Neurologic outcome in survivors of childhood arterial ischemic stroke and sinous venous thrombosis.  J Child Neurol. 2000;  15 316-324
    PubMedGoogle Scholar
  • 7 De Veber G. Arterial ischemic strokes in infants and children: an overview of current approaches.  Semin Thromb Hemost. 2003;  29 567-573
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Delsing B J, Catsman-Berrevoets C E, Appel I M. Early prognostic indicators of outcome in ischemic childhood stroke.  Pediatr Neurol. 2001;  24 283-289
    PubMedGoogle Scholar
  • 9 Ganesan V, Hogan A, Shack N, Gordon A, Isaacs E, Kirkham F J. Outcome after ischemic stroke in childhood.  Dev Med Child Neurol. 2000;  42 455-461
    CrossrefPubMedGoogle Scholar
  • 10 Ganesan V, Ng V, Chong W K, Kirkham F J, Connelly A. Lesion volume, lesion location, and outcome after middle cerebral artery territory stroke.  Arch Dis Child. 1999;  81 295-300
    CrossrefPubMedGoogle Scholar
  • 11 Giedd J. Brain development, IX: Human brain growth.  Am J Psychiatry. 1999;  156 4
    PubMedGoogle Scholar
  • 12 Giedd J, Blumenthal J, Jeffries N, Castellanos F X, Liu H, Zijdenbos A. et al . Brain development during childhood and adolescence: a longitudinal MRI study.  Nat Neurosci. 1999;  2 861-863
    CrossrefPubMedGoogle Scholar
  • 13 Goodman R, Yude C. IQ and its predictors in childhood hemiplegia.  Dev Med Child Neurol. 1996;  38 881-890
    PubMedGoogle Scholar
  • 14 Härtel C, Schilling S, Sperner J, Thyen U. The clinical outcomes of neonatal and childhood stroke: review of the literature and implications for future research.  Eur J Neurol. 2004;  11 431-438
    CrossrefPubMedGoogle Scholar
  • 15 Hogan A M, Kirkham F J, Isaacs E B. Intelligence after stroke in childhood: review of the literature and suggestions for future research.  J Child Neurol. 2000;  15 325-332
    PubMedGoogle Scholar
  • 16 Kaufman A S, Kaufman N L. Kaufman Assessment Battery for Children (K‐ABC). Circle Pines, Minn; American Guidance Service 1983
    Google Scholar
  • 17 Kretschman H, Kammradt G, Krauthausen I, Sauer B, Wingert F. Brain growth in man.  Biblio Anat. 1986;  28 1-26
    PubMedGoogle Scholar
  • 18 Levine S C, Huttenlocher J, Taylor A, Langrock A. Early sex differences in spatial skill.  Dev Psychol. 1999;  35 940-949
    CrossrefPubMedGoogle Scholar
  • 19 Lynch J K, Nelson K B. Epidemiology of perinatal stroke.  Curr Opin Pediatr. 2001;  13 499-505
    CrossrefPubMedGoogle Scholar
  • 20 Max J E, Mathews K, Lansing A. et al . Psychiatric disorders after childhood stroke.  J Am Acad Child Adolesc Psychiatry. 2002;  41 555-562
    PubMedGoogle Scholar
  • 21 McFie J. Intellectual impairment in children with localised post-infantile cerebral lesions.  J Neurol Neurosurg Psychiatry. 1961;  24 361-365
    PubMedGoogle Scholar
  • 22 Mercuri E, Cowan F, Gupte G, Manning R, Laffan M, Rutherford M. et al . Prothrombotic disorders and abnormal neurodevelopmental outcome in infants with neonatal cerebral infarction.  Pediatrics. 2001;  107 1400-1404
    CrossrefPubMedGoogle Scholar
  • 23 Moulden J A, Persinger M A. Visuospatial/vocabulary differences in boys and girls and a potential age-dependent drift in vocabulary proficiency.  Percept Mot Skills. 1996;  82 472-474
    PubMedGoogle Scholar
  • 24 Muter V, Taylor S, Vargha-Khadem F. A longitudinal study of early intellectual development in hemiplegic children.  Neuropsychologia. 1997;  35 289-298
    CrossrefPubMedGoogle Scholar
  • 25 Nelson K, Lynch J. Stroke in newborn infants. Review.  Lancet Neurol. 2004;  3 150-158
    CrossrefPubMedGoogle Scholar
  • 26 Ramaswamy V, Miller S P, Barkovich A J, Partridge J C, Ferriero D M. Perinatal stroke in term infants with neonatal encephalopathy.  Neurology. 2004;  62 2088-2091
    PubMedGoogle Scholar
  • 27 Reiss A L, Abrams M, Singer H, Ross J, Denckla M. Brain development, gender and IQ in children. A volumetric imaging study.  Brain. 1996;  119 1763-1774
    PubMedGoogle Scholar
  • 28 Riva D, Cazzaniga L. Late effects of unilateral brain lesions sustained before and after age one.  Neuropsychologia. 1986;  24 423-428
    CrossrefPubMedGoogle Scholar
  • 29 Sreenan C, Bhargava R, Robertson C M. Cerebral infarction in the term newborn: clinical presentation and long-term outcome.  J Pediatr. 2000;  137 351-355
    CrossrefPubMedGoogle Scholar
  • 30 Staudt M, Lidzba K, Grodd W, Wildgruber D, Erb M, Krägeloh-Mann I. Right-hemispheric organization of language following early left-sided brain lesions: functional MRI topography.  Neuroimage. 2002;  16 954-996
    CrossrefPubMedGoogle Scholar
  • 31 Steinlin M, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone Mori A. et al . The first three years of the Swiss Neuropaediatric Stroke Registry (SNPSR): A population-based study of incidence, symptoms, risk factors and short term outcome.  Neuropediatrics. 2005;  36 90-97
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Steinlin M, Roellin K, Schroth G. Long-term follow-up after stroke in childhood.  Eur J Pediatr. 2004;  163 245-250
    CrossrefPubMedGoogle Scholar
  • 33 Tewes U. Hamburg-Wechsler Intelligenztest für Erwachsene. Revision 1991. HAWIE‐R 2. korrigierte Auflage. Bern; Verlag Hans Huber 1994
    Google Scholar
  • 34 Tewes U. Hamburg-Wechsler-Intelligenztest für Kinder, Revision. Bern; Verlag Hans Huber 1983
    Google Scholar
  • 35 Vargha-Khadem F, Isaacs E, Van der Werf S, Robb S, Wilson J. Development of intelligence and memory in children with hemiplegic cerebral palsy.  Brain. 1992;  115 315-329
    CrossrefPubMedGoogle Scholar
  • 36 Warrington E K, James M, Maciejewski C. The WAIS as a lateralizing and localizing diagnostic instrument: a study of 656 patients with unilateral cerebral lesions.  Neuropsychologia. 1986;  24 223-239
    CrossrefPubMedGoogle Scholar

MD Julia Pavlovic

University Children's Hospital
Inselspital

3010 Bern

Switzerland

Phone: + 41316329424

Fax: + 41 316 32 95 00

Email: julia.pavlovic@insel.ch

      >