TY - JOUR
T1 - Stroke in the Developing Brain
T2 - Neurophysiologic Implications of Stroke Timing, Location, and Comorbid Factors
AU - Hill, Nayo M.
AU - Malone, Laura A.
AU - Sun, Lisa R.
N1 - Funding Information:
Dr. Hill receives funding from a National Institutes of Health training grant (NIHT32HD007414). Dr. Malone receives funding from the Thrasher Research Fund. Dr. Sun receives funding from the American Heart Association (Career Development Award [850044]) and the D.C. Women's Board. All authors declare that there are no conflicts of interests regarding the publication of this article.
Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/11
Y1 - 2023/11
N2 - Background: Pediatric stroke, which is unique in that it represents a static insult to a developing brain, often leads to long-term neurological disability. Neuroplasticity in infants and children influences neurophysiologic recovery patterns after stroke; therefore outcomes depend on several factors including the timing and location of stroke and the presence of comorbid conditions. Methods: In this review, we discuss the unique implications of stroke occurring in the fetal, perinatal, and childhood/adolescent time periods. First, we highlight the impact of the developmental stage of the brain at the time of insult on the motor, sensory, cognitive, speech, and behavioral domains. Next, we consider the influence of location of stroke on the presence and severity of motor and nonmotor outcomes. Finally, we discuss the impact of associated conditions on long-term outcomes and risk for stroke recurrence. Results: Hemiparesis is common after stroke at any age, although the severity of impairment differs by age group. Risk of epilepsy is elevated in all age groups compared with those without stroke. Outcomes in other domains vary by age, although several studies suggest worse cognitive outcomes when stroke occurs in early childhood compared with fetal and later childhood epochs. Conditions such as congenital heart disease, sickle cell disease, and moyamoya increase the risk of stroke and leave patients differentially vulnerable to neurodevelopmental delay, stroke recurrence, silent infarcts, and cognitive impairment. Conclusions: A comprehensive understanding of the interplay of various factors is essential in guiding the clinical care of patients with pediatric stroke.
AB - Background: Pediatric stroke, which is unique in that it represents a static insult to a developing brain, often leads to long-term neurological disability. Neuroplasticity in infants and children influences neurophysiologic recovery patterns after stroke; therefore outcomes depend on several factors including the timing and location of stroke and the presence of comorbid conditions. Methods: In this review, we discuss the unique implications of stroke occurring in the fetal, perinatal, and childhood/adolescent time periods. First, we highlight the impact of the developmental stage of the brain at the time of insult on the motor, sensory, cognitive, speech, and behavioral domains. Next, we consider the influence of location of stroke on the presence and severity of motor and nonmotor outcomes. Finally, we discuss the impact of associated conditions on long-term outcomes and risk for stroke recurrence. Results: Hemiparesis is common after stroke at any age, although the severity of impairment differs by age group. Risk of epilepsy is elevated in all age groups compared with those without stroke. Outcomes in other domains vary by age, although several studies suggest worse cognitive outcomes when stroke occurs in early childhood compared with fetal and later childhood epochs. Conditions such as congenital heart disease, sickle cell disease, and moyamoya increase the risk of stroke and leave patients differentially vulnerable to neurodevelopmental delay, stroke recurrence, silent infarcts, and cognitive impairment. Conclusions: A comprehensive understanding of the interplay of various factors is essential in guiding the clinical care of patients with pediatric stroke.
KW - Childhood stroke
KW - Developing brain
KW - Neurological outcomes
KW - Neuroplasticity
KW - Pediatric stroke
KW - Perinatal stroke
KW - Stroke recovery
UR - http://www.scopus.com/inward/record.url?scp=85169006722&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85169006722&partnerID=8YFLogxK
U2 - 10.1016/j.pediatrneurol.2023.08.008
DO - 10.1016/j.pediatrneurol.2023.08.008
M3 - Review article
C2 - 37651976
AN - SCOPUS:85169006722
SN - 0887-8994
VL - 148
SP - 37
EP - 43
JO - Pediatric Neurology
JF - Pediatric Neurology
ER -