Clinical Predictors of Attention and Executive Functioning Outcomes in Children After Perinatal Arterial Ischemic Stroke

Publication date: Available online 25 January 2017
Source:Pediatric Neurology
Author(s): Danielle D. Bosenbark, Lauren Krivitzky, Rebecca Ichord, Arastoo Vossough, Aashim Bhatia, Laura E. Jastrzab, Lori Billinghurst
BACKGROUNDChildren with perinatal arterial ischemic stroke (PAIS) are at risk for later neurocognitive and behavioral deficits, yet clinical predictors of these outcomes are understudied. We examined the influence of clinical and infarct characteristics on attention and executive functioning in children following PAIS.METHODSForty children born at term (≥37 weeks gestation) with PAIS (28 neonatal AIS (NAIS), 12 presumed perinatal AIS (presumed PAIS)) underwent a comprehensive neuropsychological battery at ages 3-16 years (median age 7.2 years; 58% male) to assess attention and executive functioning. Parents also completed questionnaires regarding real-world functioning. Clinical variables including perinatal stroke subtype, infarct characteristics (location, laterality, and volume), and the presence of comorbid epilepsy were ascertained from the medical record.RESULTSPresumed PAIS, larger infarct volume, and comorbid epilepsy negatively influenced performance on attention and executive functioning measures. These clinical variables were also associated with greater functional problems on parent report, including a higher incidence of clinically elevated ADHD symptoms and greater difficulties in some sub-domains of executive functioning. Infarct location and laterality were not associated with performance measures or parental report of functioning.CONCLUSIONWhile all children with PAIS are at risk for later deficits in attention and executive functioning, those with presumed PAIS, larger infarct size, and co-morbid epilepsy appear to be most vulnerable. As they approach and reach school age, these children should undergo neuropsychological assessment to ensure timely implementation of therapeutic interventions and behavioral strategies.



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