University of California, San Diego, La Jolla, California; Rady Children's Hospital, San Diego, California.
Pediatr Neurol. 2014 Jan;50(1):18-25. doi: 10.1016/j.pediatrneurol.2013.08.029. Epub 2013 Nov 1.
Pediatric neurologists and neonatologists often are asked to predict cognitive outcome after perinatal brain injury (including likely memory and learning outcomes). However, relatively few data exist on how accurate predictions can be made. Furthermore, although the consequences of brain injury on hippocampal volume and memory performance have been studied extensively in adults, little work has been done in children.
We measured the volume of the hippocampus in 27 children with perinatal stroke and 19 controls, and measured their performance on standardized verbal and non-verbal memory tests.
We discovered the following: (1) As a group, children with perinatal stroke had smaller left and right hippocampi compared with control children. (2) Individually, children with perinatal stroke demonstrated 1 of 3 findings: no hippocampal loss, unilateral hippocampal loss, or bilateral hippocampal volume loss compared with control children. (3) Hippocampal volume inversely correlated with memory test performance in the perinatal stroke group, with smaller left and right hippocampal volumes related to poorer verbal and non-verbal memory test performance, respectively. (4) Seizures played a significant role in determining memory deficit and extent of hippocampal volume reduction in patients with perinatal stroke.
These findings support the view that, in the developing brain, the left and right hippocampi preferentially support verbal and nonverbal memory respectively, a consistent finding in the adult literature but a subject of debate in the pediatric literature. This is the first work to report that children with focal brain injury incurred from perinatal stroke have volume reduction in the hippocampus and impairments in certain aspects of declarative memory.
儿科神经科医生和新生儿科医生经常被要求预测围产期脑损伤后的认知结果（包括可能的记忆和学习结果）。然而，能够做出准确预测的相关数据相对较少。此外，尽管成人的海马体积和记忆表现与脑损伤的后果之间的关系已得到广泛研究，但在儿童中几乎没有开展相关工作。
我们测量了 27 名围产期卒中患儿和 19 名对照儿童的海马体体积，并测量了他们在标准化言语和非言语记忆测试中的表现。
我们发现：（1）作为一个整体，围产期卒中患儿的左、右海马体均小于对照组儿童。（2）个体而言，围产期卒中患儿表现出 3 种发现之一：与对照组儿童相比，无海马体丢失、单侧海马体丢失或双侧海马体体积丢失。（3）围产期卒中组的海马体体积与记忆测试表现呈负相关，左、右海马体体积越小，言语和非言语记忆测试表现越差。（4）癫痫发作在确定围产期卒中患者的记忆缺陷和海马体体积减少程度方面起着重要作用。
这些发现支持这样一种观点，即在发育中的大脑中，左、右海马体分别优先支持言语和非言语记忆，这是成人文献中的一致发现，但在儿科文献中存在争议。这是第一项报告表明，围产期卒中导致局灶性脑损伤的儿童的海马体体积减小，并在某些陈述性记忆方面存在障碍。
