Abstract 72: Evolution Of Cerebral Diaschisis In Childhood Arterial Ischemic Stroke
Objectives: Early diffusion MRI (DWI) demonstrates acute restriction in corticospinal pathways after arterial ischemic stroke (AIS) that correlate with outcome. DWI may also detect changes in other remote but connected brain structures in neonatal AIS. We have termed this diaschisis and hypothesized here that the same process can be measured in childhood AIS and evolves over time.
Methods: This substudy of the Validation of the Pediatric NIH Stroke Scale study prospectively enrolled 112 children with acute AIS and both acute and early follow-up (5-14 days) DWI. Inclusion criteria here were: (1) unilateral AIS (MCA), (2) acute and subacute DWI (b=1000/1500), and (3) 12 month neurological follow-up (Pediatric Stroke Outcome Measure). A validated method using Image J software quantified DWI diaschisis in anatomically connected structures. Diaschisis measures were corrected for infarct volume, and compared to imaging timing and outcome (Chi-square/Fisher, Mann-Whitney).
Results: Fifteen children were evaluated (60% male, median 9.3 years). Median times to MRI were 17 and 168 hours respectively. Diaschisis was common and evolved over time; observed in 1(7%) on the 1st MR but 5(33%) by the 2nd MR. Thalamic and callosal diaschisis were most common (4, 27%). Children with diaschisis tended to be younger (7.02±5.4vs11.82±4.3years, p=0.08). Estimates of perilesional diaschisis varied (54±18% of infarct volume). Most children with poor outcome had diaschisis (3/5) while most with good outcome did not (8/10,p=0.12). Corticospinal tract DWI changes correlated with motor outcome (p=0.005). Method reliability was excellent (ρ=0.99).
Conclusions: DWI diaschisis occurs in childhood AIS. Mistaking diaschisis for new areas of infarction carries important clinical implications. Improved recognition and study are required to establish clinical relevance.
- © 2012 by American Heart Association, Inc.