Brain Volume and Cognition at School Age after Perinatal Arterial Ischemic Stroke (PAIS)
Summary
Background: Perinatal arterial ischemic stroke (PAIS) can lead to severe neurodevelopmental issues, including cognitive deficits. The extent of impairment has been linked to stroke volume and location. Larger strokes may disrupt brain development and cause greater cognitive deficits. Consequences of PAIS are mostly assessed in pre-schoolers, although some may not appear until school age. This study aimed to explore how PAIS impacts brain development and cognitive function at school age. We hypothesised that stroke volume would negatively impact brain volume at school age and cognitive outcomes, and that stroke location would also be associated with these outcomes.
Methods: Forty-four children were selected from the Neonatal Stroke Registry Utrecht. Eligible children had unilateral PAIS, were diagnosed neonatally, and were between 8 and 14 years at testing. Neonatal T2 and diffusion-weighted images were used to extract stroke volume and location. A follow-up MRI at school age assessed brain development. Cognitive outcomes were evaluated using the Wechsler Intelligence Scale for Children (WISC-V-NL).
Results: Neonatal stroke volume negatively correlated with total brain volume and ipsilesional hemisphere volume, but not contralesional volume. Stroke volume was also negatively associated with FSIQ and all primary indices. Stroke location was associated with brain volumes and cognition, with main branch MCA involvement showing the most adverse outcomes. Total and ipsilesional brain volumes at school age were positively associated with all cognitive index scores except the Working Memory Index.
Conclusion: Stroke volume and location are significantly associated with ipsilesional hemisphere volumes and cognitive functioning at school age. Neonatal imaging, particularly PAIS volume, may serve as an early predictor of brain development and long-term IQ. Improving our understanding of neurodevelopmental outcomes after PAIS can help identify children at risk for impairment and ensure better support, emphasizing the need for extended follow-up in affected children.