Early childhood particularly vulnerable period for negative stroke outcomes

Age at pediatric stroke has a significant impact on post-stroke recovery and affects long-term cognitive outcome regardless of lesion size and lesion location, according to results of a cross-sectional study published in Neurology.

“Brain insults during a critical period of cognitive development likely entail poorer cognitive outcome compared to brain injuries occurring before or after the emergence of a cognitive function,” Stephanie Abgottspon, MSc, of the department of pediatrics at Bern University Hospital in Switzerland, and colleagues wrote. “Moreover, cognitive functions, in particular executive functions, are strongly associated with quality of life, scholastic achievement and social competence, which highlights the importance to monitor post-stroke cognitive outcome.

“In the present study, we aimed to examine long-term cognitive outcome following pediatric stroke in the chronic stage (older than 2 years after stroke) and to investigate whether age at stroke impacts on cognition in order to identify patients at risk for poor cognitive outcome,” they added.

Researchers compared outcomes of 52 patients (median age, 15.3 years) in the chronic phase of stroke with a prior diagnosis of neonatal or childhood arterial ischemic stroke with those of 49 healthy controls (median age, 13.6 years). They excluded those with active epilepsy, severe learning difficulties or behavioral problems that impeded the cognitive assessment. Via neuropsychological tests, they examined several cognitive domains, such as intelligence, executive functions, processing speed, memory, letter fluency and visual-motor skills. Further, Abgottspon and colleagues compared cognitive long-term outcome across patients after neonatal stroke (between 0 and 28 days of life), early childhood stroke (between 29 days and younger than age 6 years) and late childhood stroke (between age 6 years and younger than 16 years).

Patients in the pediatric stroke group had significantly worse cognitive outcome compared with the control group. Researchers noted a nonlinear effect of age at stroke, regardless of lesion size and lesion location, for cognitive flexibility, processing speed and verbal learning with early childhood stroke demonstrating significantly worse cognitive outcome compared with neonatal or late childhood stroke.

“These results propose that early childhood is a particular vulnerable developmental period for negative long-term cognitive outcome in survivors of pediatric stroke, irrespective of lesion size and lesion location,” Abgottspon and colleagues wrote. “Children following early childhood stroke should be monitored closely and provided with adequate treatment and rehabilitation options tailored on their age at stroke and current developmental period in order to prevent cognitive sequelae and improve cognitive outcome.”