Abstract
Objective
Sickle-cell anemia is a leading congenital cause of stroke in childhood. Such strokes can lead to cognitive deficits, stroke in the prefrontal cortex leading to inattention, impulsivity, and poor executive control. This case study examines a 23-year-old African American male who suffered from a stroke in his prefrontal cortex at age 3. Neuroimaging confirmed stroke location, but the patient had an atypical pattern of reported cognitive deficits.
Method
The patient was assessed in an out-patient practice. The individual was assessed with a clinical interview and comprehensive Neuropsychological Battery. The battery included cognitive and psychological measures with free-standing and imbedded validity measures.
Results
Cognitive testing demonstrated significant impairment in visuospatial processing speed, visual abilities, and decision making and executive control. This pattern of impairment suggests that the patient is still suffering from his stroke, which likely damaged the connective tissue of the occipital and parietal lobes, and the prefrontal cortex. The patient was diagnosed with Mild Neurocognitive Disorder in perceptual-motor and executive functioning.
Conclusions
These results suggest that despite the neuroplastic abilities of the brain at early ages, the neurodevelopment of individuals who suffer from stroke in early childhood is likely to be altered and contributes to cognitive impairments in early adulthood. Long-term cognitive sequelae in the form of deficits in visual perceptual skills, suggest that frontal connections to other regions in the brain may be impacted. Therefore, this case highlights that even a localized stroke in a child can lead to broader deficits if that area of the brain interacts with other areas.
Pathways from early adversity to later adjustment: Tests of the additive and bidirectional effects of executive control and diurnal cortisol in early childhood – Corrigendum
