Department of Paediatric Neuropsychology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Dev Med Child Neurol. 2013 Oct;55(10):934-40. doi: 10.1111/dmcn.12187. Epub 2013 Jun 13.
The aim of the study was to assess cognitive outcome in children with periventricular haemorrhagic infarction (PVHI) or perinatal arterial ischaemic stroke (PAIS) and relate these findings to early developmental outcome and neonatal magnetic resonance imaging findings.
A neuropsychological assessment was performed in 50 children (26 males, 24 females) with unilateral PVHI (n=21) or PAIS (n=29) at a median age of 11 years 9 months (range 6-20y). This included tests for intelligence, verbal memory, visual-motor integration, word comprehension, attention, reaction times, and executive function. The Griffiths Mental Development Scale was used for early developmental assessment at 24 months (range 18-32mo).
In children with PVHI, both the early Griffiths scores (mean 87; 95% CI 83-92) and the Full-scale IQ (FSIQ) scores at school age (mean 86; 95% CI 78-94) were below the test mean of 100. In the PAIS group, early Griffiths scores were within the normal range (mean 98; 95% CI 93-104), but at school age FSIQ scores were below average (mean 87; 95% CI 80-94). In children with PVHI, FSIQ scores correlated with the level of maternal education and were lower after ventricular dilatation, whereas both involvement of the basal ganglia and thalami and development of postneonatal epilepsy were associated with lower cognitive outcome in children who had experienced PAIS.
Cognitive outcome after PVHI or PAIS is below average, but still within 1SD for most children. Prediction of cognitive outcome remains challenging, but some early predictors can be recognized.
本研究旨在评估患有脑室内出血性梗死（PVHI）或围产期动脉缺血性卒中（PAIS）患儿的认知结局，并将这些发现与早期发育结局和新生儿磁共振成像结果相关联。
在中位年龄为 11 岁 9 个月（范围 6-20 岁）时，对 50 名单侧 PVHI（n=21）或 PAIS（n=29）患儿进行神经心理学评估。该评估包括智力、言语记忆、视动整合、词汇理解、注意力、反应时间和执行功能测试。24 个月时（范围 18-32 个月）使用 Griffiths 精神发育量表进行早期发育评估。
PVHI 患儿的 Griffiths 早期评分（均值 87；95%CI 83-92）和学龄期的全量表智商（FSIQ）评分（均值 86；95%CI 78-94）均低于测试均值 100。PAIS 组的 Griffiths 早期评分在正常范围内（均值 98；95%CI 93-104），但学龄期的 FSIQ 评分低于平均水平（均值 87；95%CI 80-94）。在 PVHI 患儿中，FSIQ 评分与母亲的教育水平相关，且在脑室扩张后评分更低，而基底节和丘脑受累以及新生儿后癫痫的发生与经历过 PAIS 的患儿认知结局较差相关。
PVHI 或 PAIS 后的认知结局低于平均水平，但大多数患儿仍在 1SD 范围内。对认知结局的预测仍然具有挑战性，但可以识别出一些早期预测因素。
