The relationship between early neurological impairment, stroke characteristics and functional outcome at six and twelve months following paediatric stroke.

Abstract

Objective: Bilateral lesions and early neurological impairments have been associated with poorer neurological outcomes in cross-sectional paediatric stroke studies. The relationship with daily life abilities in the months following diagnosis has not been described prospectively. The purpose of this study was to explore the relationship between lesion characteristics and early neurological impairment, with adaptive functional outcomes at 6 and 12months following stroke diagnosis. Design(s): Prospective hospital-based cohort study. Method(s): Twenty-seven children admitted to a tertiary level paediatric hospital were recruited at time of diagnosis of first arterial ischaemic stroke. Two neuroradiologists classified lesion characteristics including infarct laterality, number of infarcts and vascular territory. Neurological examinations were undertaken from early hospital admission and repeated throughout a 12-month period. Functional outcome as measured by the Vinelands Adaptive Behavior Scales was undertaken at 6 and 12months. Result(s): One third of children sustained unilateral anterior territory infarctions. Infratentorial lesions alone were seen in 6/27 and 6/27 had bilateral infarctions. Neurological impairments overall decreased over time, with most rapid improvement in the first 3 to 6months. Adaptive behavior impairments emerged over time. Neither lesion characteristics, nor acute or one month neurological impairment totals were correlated with adaptive behavior at 6 or 12months. Conclusion(s): Neither severity of neurological impairment nor lesion characteristics were found to be associated with degree of functional impairment at 6 or 12months following stroke diagnosis.