Murphy Lexa K, Compas Bruce E, Gindville Melissa C, Reeslund Kristen L, Jordan Lori C
Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA.
Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
Dev Med Child Neurol. 2017 Nov;59(11):1146-1151. doi: 10.1111/dmcn.13547. Epub 2017 Sep 6.
Previous research investigating outcomes after pediatric intracerebral hemorrhage (ICH) has generally been limited to global and sensorimotor outcomes. This study examined cognitive outcomes after spontaneous ICH in school-aged children with serial assessments over 2 years after stroke.
Seven children (age range 6-16y, median 13; six males, one female; 57% white, 43% black) presenting with spontaneous ICH (six arteriovenous malformations) were assessed at 3 months, 12 months, and 24 months after stroke. The Pediatric Stroke Outcome Measure (PSOM) quantified neurological outcome and Wechsler Intelligence Scales measured cognitive outcomes: verbal comprehension, perceptual reasoning, working memory, and processing speed.
PSOM scales showed improved neurological function over the first 12 months, with mild to no sensorimotor deficits and moderate overall deficits at 1- and 2-year follow-ups (median 2-year sensorimotor PSOM=0.5, total PSOM=1.5). Changes in cognitive function indicated a different trajectory; verbal comprehension and perceptual reasoning improved over 24 months; low performance was sustained in processing speed and working memory. Age-normed centile scores decreased between 1- and 2-year follow-ups for working memory, suggesting emerging deficits compared with peers.
Early and serial cognitive testing in children with ICH is needed to assess cognitive functioning and support children in school as they age and cognitive deficits become more apparent and important for function.
In children with intracerebral hemorrhage (ICH), motor function improved between 3 months and 24 months. Improvements in cognitive function were variable between 3 months and 24 months. Working memory centiles declined, suggesting emerging deficits compared with peers. Processing speed improved but remained significantly below the 50th centile. Cognitive impact of ICH may increase with age in children.
以往关于小儿脑出血（ICH）后预后的研究通常局限于整体和感觉运动功能预后。本研究对学龄期儿童自发性ICH后2年进行系列评估，以检查认知功能预后。
7名出现自发性ICH（6例动静脉畸形）的儿童（年龄范围6 - 16岁，中位数13岁；6名男性，1名女性；57%为白人，43%为黑人）在卒中后3个月、12个月和24个月接受评估。小儿卒中预后量表（PSOM）量化神经功能预后，韦氏智力量表测量认知功能预后：言语理解、知觉推理、工作记忆和处理速度。
PSOM量表显示在最初12个月神经功能有所改善，在1年和2年随访时存在轻度至无感觉运动功能缺损以及中度整体功能缺损（2年感觉运动PSOM中位数 = 0.5，总PSOM = 1.5）。认知功能变化显示出不同轨迹；言语理解和知觉推理在24个月内有所改善；处理速度和工作记忆维持低水平表现。工作记忆的年龄标准化百分位数在1年和2年随访之间下降，表明与同龄人相比出现功能缺损。
需要对ICH患儿进行早期和系列认知测试，以评估认知功能，并在患儿成长过程中支持他们上学，因为随着年龄增长，认知缺损对功能变得更加明显和重要。
在脑出血（ICH）患儿中，运动功能在3个月至24个月之间有所改善。认知功能在3个月至24个月之间的改善情况各不相同。工作记忆百分位数下降，表明与同龄人相比出现功能缺损。处理速度有所改善，但仍显著低于第50百分位数。ICH对儿童认知的影响可能随年龄增长而增加。
