Cognitive and psychosocial functioning of children aged 8 to 14 years following perinatal arterial ischemic stroke

Background Neurodevelopmental problems in children with perinatal arterial ischemic stroke (PAIS) might be underestimated due to limited follow-up and selective evaluation of neurodevelopmental domains. This study describes school-age multidomain functioning after PAIS, and assesses MRI correlates associated with functioning. Methods This observational cross-sectional study assessed intelligence, verbal memory, sustained attention, executive functioning (EF), behavior, quality of life, and fatigue of 8-14-year-old children (n=43) with PAIS. Children underwent a neonatal and school age MRI to assess stroke and brain tissue volumes. Results At a median age of 12.6 years (IQR 3.4), 41 children (95%) exhibited below average scores on at least one tested domain. Mean visual spatial, delayed recall memory and sustained attention scores were significantly lower compared with the normative mean, while full scale IQ and EF scores were within the average range. Behavioral problems, primarily internalizing problems, and a reduced quality of life were reported in 40% (n=17), while up to 63% (n=20-27) reported increased fatigue. Larger stroke size was associated with lower scores on all IQ and EF scales. School-age deep grey matter volumes were positively linked to visual-spatial cognition, processing speed, long-term memory, and attention scores. Conclusions A significant part of children with PAIS experienced difficulties in higher-order cognitive functions and behavior, while reporting fatigue and a reduced quality of life. MRI correlates partly explained functional differences. Evaluating a child's multidomain functioning after PAIS is necessary to create a personalized support framework that benefits both the child and its family.