Cognitive functioning after stroke in childhood – a clinical study

Objectives: To provide a better understanding of cognitive functioning after childhood stroke and to study the relationship of some variables known to have an impact on outcome.

Material and Methods: 23 patients (15 boys) who suffered from stroke between birth and their 18th year of life underwent a neuropsychological assessment (Wechsler Intelligence Scale WISC-III, Test Battery of Attention TAP).

Results: Intelligence Quotients (IQ) of patients were situated within normal range (Full Scale IQ=96.5, standard deviation, sd=15.0, Verbal IQ=99.3, sd=14.3, Performance IQ=92.0, sd=21.3). However, according to the chi-square test significantly more children showed cognitive performances deviating from the norm than in the normal population in various domains: Performance IQ (p=.000), processing speed (p=.006), visuo-constructive skills (bloc design, p=.042, object assembling p=.001, picture arrangement p=.001), auditory short term memory (digit span, p=.000), logical/abstract thinking (arithmetics p=.042), alertness (median, p=.002), and divided attention (median, p=.042). Behaviour disturbances (e.g. increased aggression, antisocial behaviour, lack of self confidence) and symptoms of attention deficit hyperactivity disorder occurred in 58% and 43% respectively. Children who suffered from stroke in their early (0–4;11 years) or late childhood (10–17;11 years) showed significantly worse cognitive performance in WISC-III than children who suffered from stroke between 5–9;11 years. Other variables such as size of lesion, age at examination, elapsed time since stroke, hemispheric side of lesion, and gender did only have a marginal or no impact on prognosis.

Conclusions: Mild general cognitive deficits as well as behavioural and psychopathological problems often remain after stroke in childhood. Age at time of stroke was the most reliable predictor of cognitive outcome, whilst size of lesion, age at examination, elapsed time since stroke, hemispheric side of lesion, and gender did not have an impact on cognitive functions after childhood stroke.