on December 27, 2007
Published online before print December 27, 2007, doi: 10.1161/STROKEAHA.107.489831
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Submitted on April 2, 2007
From the Departments of Paediatrics and Imaging Sciences (D.R., E.M., A.B., R.R., L.H., M.R., L.D., F.Cowen), Imperial College Hammersmith Hospital, London, UK; the Division of Child Neurology (D.R., E.M.), Catholic University, Rome, Italy; the Department of Psychology (A.B.), Oxford Brookes University, Oxford, UK; the Neonatal Unit (F.Cota), Catholic University, Rome, Italy; and the Department of Pediatric Neurology (L.H.), Turku University Hospital, Turku, Finland. * To whom correspondence should be addressed. E-mail: f.cowan{at}imperial.ac.uk.
Background and Purpose—To assess cognitive outcome at early school age in term-born children with middle cerebral arterial (MCA) territory infarction of perinatal onset and examine the correlation between cognitive abilities and the extent of lesions as seen on neonatal MRI, epilepsy, and hemiplegia. Methods—Thirty-one children were seen as newborns with an acutely evolving MCA territory infarction documented on neonatal MRI scan. IQ was assessed (WIPPSI/WISC where appropriate) and they had a standardized neurological examination at early school age. Lesion(s) site was recorded from the neonatal images. Results—Twenty-eight of 31 children were assessed (median age 5.75 range 5.33 to 10.33 years); 1 child died and 2 were abroad. IQ was within the normal range (mean 104, range 82 to 144) in 21 (78%); 1 child did not complete all tests but had a normal PIQ; 3 had a low and 3 an exceptionally low IQ. Verbal IQs were more varied and lower than performance IQs especially in children from multilingual backgrounds. There was no consistent association between cognitive impairment, side, or extent of the MCA lesion. Cognitive impairments were more frequent in children with seizures or hemiplegia. All 6 children with low IQ also had behavioral problems or unusual associated clinical or scan features. Conclusions—In our cohort a low IQ at early school age did not occur in children with the common presentation of neonatal unilateral MCA territory infarction. Cognitive impairment appeared more frequently when an MCA arterial territory infarction, even if relatively small, was associated with other risk factors.
Revised on July 4, 2007
Accepted on July 12, 2007
Cognitive Outcome at Early School Age in Term-Born Children With Perinatally Acquired Middle Cerebral Artery Territory Infarction
Daniela Ricci MD;
Key words: cognitive outcome • infarction • middle cerebral artery • MRI • neonate