scholarly journals Long-Term Risk of Epilepsy After Pediatric Stroke and Potential Genetic Vulnerabilities

Stroke ◽  
2021 ◽  
Author(s):  
Lauren A. Beslow ◽  
Ingo Helbig ◽  
Christine K. Fox
Keyword(s):  
Pediatric Stroke

scholarly journals Diffusion imaging of cerebral diaschisis in neonatal arterial ischemic stroke

2015 ◽  
Vol 42 (S1) ◽  
pp. S15-S15
Author(s):  
R Srivastava ◽  
T Rajapakse ◽  
J Roe ◽  
X Wei ◽  
A Kirton
Keyword(s):  
Ischemic Stroke ◽  
Diffusion Imaging ◽  
Population Based ◽  
Pediatric Stroke ◽  
Arterial Ischemic Stroke ◽  
Long Term Outcomes ◽  
Primary Injury

Background: Neonatal arterial ischemic stroke (NAIS) is a leading cause of brain injury and cerebral palsy. Diffusion-weighted imaging (DWI) has revolutionized NAIS diagnosis and outcome prognostication. Diaschisis refers to changes in brain areas functionally connected but structurally remote from primary injury. We hypothesized that acute DWI can demonstrate cerebral diaschisis and evaluated associations with outcome. Methods: Subjects were identified from a prospective, population-based research cohort (Calgary Pediatric Stroke Program). Inclusion criteria were unilateral middle cerebral artery NAIS, DWI MRI within 10 days of birth, and >12-month follow-up (Pediatric Stroke Outcome Measure, PSOM). Diaschisis was quantified using a validated software method. Diaschisis-scores were corrected for infarct size and compared to outcomes (Mann-Whitney). Results: From 20 eligible NAIS, 2 were excluded for image quality. Of 18 remaining, 16 (89%) demonstrated diaschisis. Thalamus (88%) was most often involved. Age at imaging was not associated with diaschisis. Long-term outcomes available on 13 (81%) demonstrated no association between diaschisis score and PSOM categories. Conclusion: Cerebral diaschisis occurs in NAIS and can be quantified with DWI. Occurrence is common and should not be mistaken for additional infarction. Determining additional clinical significance will depend on larger samples with long-term outcomes.

Long-Term Cognitive Outcomes After Pediatric Stroke

2011 ◽  
Vol 44 (2) ◽  
pp. 101-109 ◽  
Author(s):  
Anneli Kolk ◽  
Margus Ennok ◽  
Rael Laugesaar ◽  
Mari-Liis Kaldoja ◽  
Tiina Talvik
Keyword(s):  
Cognitive Outcomes ◽  
Pediatric Stroke

Abstract TMP101: Impact of Age at Stroke on Cognitive Outcome in Children: Selective Vulnerability of Younger Children

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Patricia Plumb ◽  
Peter L Stavinoha ◽  
Alice A Holland ◽  
Michael M Dowling
Keyword(s):  
Quality Of Life ◽  
Cognitive Outcome ◽  
Stroke Severity ◽  
Pediatric Stroke ◽  
Factors Associated ◽  
Stroke Etiology ◽  
Younger Age ◽  
The Impact

Background & Purpose: Long term cognitive deficits among pediatric stroke survivors have a significant impact on quality of life and long term functional outcome. The degree to which age at stroke relates to cognitive outcome is not clear, with some literature suggesting that younger age at stroke results in worse cognitive outcome. The present study investigated the impact of age at stroke on cognitive outcome measured by IQ in a pediatric sample with mixed stroke etiology. Methods: Subjects were 47 children (62% male) with mixed stroke etiology including sickle cell disease (23%), cardiac disease (15%), vascular disease (17%), and traumatic injury (11%) who were seen for neuropsychological evaluation as part of long-term clinical care, at which time an IQ score was obtained. Age at stroke, location, and etiology were gathered from records and considered for analysis. Results: Mean IQ for the sample was 83.68, although scores ranged from 45 to 121. There was a significant correlation between IQ and age at stroke (r = .290, p = .048), with younger age at stroke associated with lower IQ. When males and females were studied separately, this correlation was not significant for males (r = .305, p = .106) but was significant for females (r = .612, p = .007). A simultaneous linear regression model including age at stroke, gender, etiology, and stroke location significantly predicted variance in IQ (R = .543, F = 4.382, p = .005). Age at stroke and gender were the only two predictors that significantly contributed to the model. Conclusions: We found a significant correlation between stroke age and IQ, with younger stroke age associated with lower IQ. Results suggest a possible gender difference, with females in our sample more vulnerable to lower IQ as a function of younger age at stroke. Combining stroke age, gender, etiology, and stroke location accounted for a significant amount of IQ variance. Further research is necessary to clarify factors associated with outcome in survivors of pediatric stroke and should include factors such as stroke severity and socioeconomic status. Improved understanding of factors associated with cognitive outcome following pediatric stroke may inform clinical management to hopefully improve cognitive outcomes and quality of life in this population.

Abstract 172: Medical and Demographic Predictors of Long-term Cognitive Outcomes of Pediatric Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alice A Holland ◽  
Kimberly D Goodspeed ◽  
Patricia Plumb ◽  
Peter L Stavinoha ◽  
Michael Dowling
Keyword(s):  
Neurological Impairment ◽  
Cognitive Outcomes ◽  
Stroke Severity ◽  
Pediatric Stroke ◽  
Post Stroke ◽  
Age Related ◽  
Long Term Follow Up ◽  
The Relationship

Introduction: Studies examining cognitive outcomes for pediatric stroke are sparse, and few account for stroke severity. The Pediatric Stroke Outcome Measure (PSOM) provides an objective, comprehensive rating of neurological impairment. This study investigated the relationship between initial PSOM score and long-term cognitive outcomes. It was hypothesized that greater severity of stroke (worse initial PSOM score) would predict lower IQ at long-term follow-up. Other factors considered were age at stroke and months post stroke. Age-related studies in broad cognitive outcomes for pediatric stroke are sparse and somewhat inconsistent in findings. It was hypothesized that severity of stroke would be more relevant than age of stroke for long-term cognitive outcomes. Methods: PSOM scores at initial visit and IQ scores at long-term follow-up (M=3.77 years) were obtained for 84 survivors of pediatric stroke ages 4:0-25:6 (M=11:5 years; 37 females). A one-sample t-test was conducted to compare mean IQ to the normative sample. To examine the hypotheses, all variables of interest (PSOM, age at stroke, and months s/p) were entered into a stepwise regression equation. Results: Mean IQ for the sample was 84.77 (SD=17.26), significantly below average relative to healthy norms ( t =-8.088, p =.000). PSOM scores ranged 0-5.5 (median/mode=1.0). The regression was significant ( F =8.798; p =.000), with both PSOM score ( b =-.350; t [80]=-3.483; p =.001) and months post stroke ( b =-.355; t [80]=-3.005; p =.004) significantly contributing to the model, but not age at stroke. Conclusions: PSOM was more relevant than age at stroke in predicting long-term cognitive outcomes, and greater stroke severity was associated with lower IQ at follow-up. Finding suggest that initial PSOM score and greater time since stroke may be more relevant to long-term cognitive outcomes than age at stroke. The present study lends validity to using the PSOM both as a marker of functional severity of stroke and a potential indicator of relative risk for poorer long-term cognitive outcomes. Better predictors of cognitive outcomes for pediatric stroke are greatly needed in order to facilitate earlier intervention/rehabilitation and improve the efficacy of such efforts.

Long-term functional and cognitive outcomes after pediatric stroke

2017 ◽  
Vol 21 ◽  
pp. e25
Author(s):  
Sh. Shamansurov ◽  
N. Tulyaganova ◽  
S. Nazarova ◽  
P. Usmanova
Keyword(s):  
Cognitive Outcomes ◽  
Pediatric Stroke

Long-Term Functional Outcome of Pediatric Stroke Survivors

2004 ◽  
Vol 11 (2) ◽  
pp. 51-59 ◽  
Author(s):  
Edward Hurvitz ◽  
Seth Warschausky ◽  
Michelle Berg ◽  
Shane Tsai
Keyword(s):  
Functional Outcome ◽  
Pediatric Stroke ◽  
Stroke Survivors

scholarly journals P.117 Pediatric acute ischemic stroke protocols

2021 ◽  
Vol 48 (s3) ◽  
pp. S52-S52
Author(s):  
M Gladkikh ◽  
H McMillan ◽  
A Andrade ◽  
C Boelman ◽  
I Bhatal ◽  
...  
Keyword(s):  
Response Rate ◽  
Treatment Options ◽  
Pediatric Stroke ◽  
Consensus Approach ◽  
Exclusion Criteria ◽  
Pediatric Hospitals ◽  
Age Dependent ◽  
Pre Treatment ◽  
Iv Tpa

Background: Approximately 1,000 children present with AIS annually in North America. Most suffer from long-term disability. Childhood AIS is diagnosed after a median of 23 hours post-symptom onset, limiting thrombolytic treatment options that may improve outcomes. Pediatric stroke protocols decrease time to diagnosis. AIS treatment is not uniform across Canada, nor are pediatric stroke protocols standardized. Methods: We contacted neurologists at all 16 Canadian pediatric hospitals regarding their AIS management. Results: Response rate was 100%. Seven centers have an AIS protocol and two have a protocol under development. Seven centers do not have a protocol – two redirect patients to adult neurology, and five use a case-by-case approach for management. Analysis of the seven AIS protocols reveals differences: 1) IV-tPA dosage: age-dependent 0.75-0.9 mg/kg (n=1) versus age-independent 0.9 mg/kg (n=6), with maximum doses 75 mg (n=1) or 90 mg (n=6); 2) IV-tPA lower age cut-off: 2 years (n=4) versus 3, 4 or 10 years (n=1); 3) IV-tPA exclusion criteria: PedNIHSS score <4 (n=3), <5 (n=1), or <6 (n=3); 4) Pre-treatment neuroimaging: CT (n=3) versus MRI (n=4); 5) Intra-arterial tPA use (n=3). Conclusions: The seven Canadian pediatric AIS protocols show prominent differences. We plan a teleconference discussing a Canadian pediatric AIS consensus approach.

Long-Term Cognitive Outcomes After Pediatric Stroke

2011 ◽  
Vol 2011 ◽  
pp. 258-259
Author(s):  
L.A. Papile
Keyword(s):  
Cognitive Outcomes ◽  
Pediatric Stroke

Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis
Keyword(s):  
Mental Health ◽  
Mental Disease ◽  
Brain Disorders ◽  
Social Stressors ◽  
Labor Education ◽  
Mental Diseases ◽  
Long Term Follow Up ◽  
Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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