Heimgärtner Magdalena, Gschaidmeier Alisa, Schnaufer Lukas, Staudt Martin, Wilke Marko, Lidzba Karen
Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.
Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany.
Front Pediatr. 2024 May 7;12:1338855. doi: 10.3389/fped.2024.1338855. eCollection 2024.
This study aims to investigate the long-term language outcome in children with unilateral childhood stroke in comparison to those with perinatal strokes and typically developing individuals and to explore the impact of lesion-specific modifiers.
We examined nine patients with childhood stroke, acquired between 0;2 and 16;1 years (CHILD; 3 female, median = 13.5 years, 6 left-sided), 23 patients with perinatal strokes (PERI; 11 female, median = 12.5 years, 16 left-sided), and 33 age-matched typically developing individuals (CONTROL; 15 female, median = 12.33 years). The language outcome was assessed using age-appropriate tasks of the Potsdam Illinois Test of Psycholinguistic Abilities (P-ITPA) or the Peabody Picture Vocabulary Test (PPVT). For group comparisons, study-specific language -scores were calculated. Non-verbal intelligence was assessed using the Test of Non-verbal Intelligence (TONI-4), language lateralization with functional MRI, and lesion size with MRI-based volumetry.
All four patients with childhood stroke who initially presented with aphasic symptoms recovered from aphasia. Patients with childhood stroke showed significantly lower language scores than those in the control group, but their scores were similar to those of the patients with perinatal stroke, after adjusting for general intelligence (ANCOVA, language -score CHILD = -0.30, PERI = -0.38, CONTROL = 0.42). Among the patients with childhood stroke, none of the possible modifying factors, including lesion side, correlated significantly with the language outcome.
Childhood stroke, regardless of the affected hemisphere, can lead to chronic language deficits, even though affected children show a "full recovery." The rehabilitation of children and adolescents with childhood stroke should address language abilities, even after the usually quick resolution of clear aphasic symptoms.
本研究旨在调查单侧儿童期卒中患儿与围产期卒中患儿及正常发育个体相比的长期语言结局，并探讨病变特异性修饰因素的影响。
我们检查了9例儿童期卒中患者，发病年龄在0;2至16;1岁之间（儿童组；3名女性，中位数=13.5岁，6例左侧病变），23例围产期卒中患者（围产期组；11名女性，中位数=12.5岁，16例左侧病变），以及33名年龄匹配的正常发育个体（对照组；15名女性，中位数=12.33岁）。使用适合年龄的波茨坦伊利诺伊心理语言能力测试（P-ITPA）或皮博迪图片词汇测试（PPVT）评估语言结局。为进行组间比较，计算了特定研究的语言分数。使用非语言智力测试（TONI-4）评估非语言智力，使用功能磁共振成像评估语言侧化，使用基于磁共振成像的容积测量评估病变大小。
所有4例最初出现失语症状的儿童期卒中患者均从失语中恢复。儿童期卒中患者的语言分数显著低于对照组，但在调整一般智力后，他们的分数与围产期卒中患者相似（协方差分析，语言分数儿童组=-0.30，围产期组=-0.38，对照组=0.42）。在儿童期卒中患者中，包括病变侧在内的所有可能的修饰因素均与语言结局无显著相关性。
儿童期卒中，无论受影响的半球如何，都可能导致慢性语言缺陷，即使受影响的儿童表现出“完全恢复”。儿童期卒中患儿及青少年的康复应关注语言能力，即使在通常较快缓解明显失语症状之后。
