Brain Structure in Prenatal Stroke: Quantitative Magnetic Resonance Imaging (MRI) Analysis

Neonatal stroke outcome studies demonstrate variable findings of either relatively spared intellectual function or persistent impairments. Volumetric measurement of the brain can provide more precise data on lesion—cognition outcomes. We studied 7 children with unilateral focal lesions from prenatal stroke. Whole-brain magnetic resonance imaging scans were analyzed to produce volumes of cortical gray matter, total white matter, cerebrospinal fluid, lesion, and lesion constricted fluid, and we ascertained the relationship of morphometric variables to intellectual and clinical outcome. Children with cystic encephalomalacia plus atrophy had poorer outcomes than children with atrophy or gliosis alone. These children also demonstrated the largest lesion size, smallest gray matter volume, and greatest proportion of hyperintense white matter in the affected hemisphere. Findings suggest that the type and size of the lesion, in addition to the integrity of white matter and residual cortex, may be better predictors of intellectual functioning than either of these indices alone.

[1]  V. Saletti,et al.  MRI features of cerebral lesions and cognitive functions in preterm spastic diplegic children. , 1996, Pediatric neurology.

[2]  D. Trauner,et al.  Neurologic profiles of infants and children after perinatal stroke. , 1993, Pediatric neurology.

[3]  J. Stiles,et al.  The impact of early unilateral brain injury on perceptual organization and visual memory , 2002, Neuropsychologia.

[4]  C. Fennema-Notestine,et al.  Effects of age on tissues and regions of the cerebrum and cerebellum , 2001, Neurobiology of Aging.

[5]  J. Buckhalt.  Book Review: Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) , 1991 .

[6]  F. Vargha-Khadem,et al.  Aphasia and handedness in relation to hemispheric side, age at injury and severity of cerebral lesion during childhood. , 1985, Brain : a journal of neurology.

[7]  Dorothy M. Aram,et al.  Intellectual stability in children with unilateral brain lesions , 1994, Neuropsychologia.

[8]  J. Max.  Effect of side of lesion on neuropsychological performance in childhood stroke , 2004, Journal of the International Neuropsychological Society.

[9]  M. Järvelin,et al.  Magnetic resonance imaging of periventricular leukomalacia and its clinical correlation in children , 1997, Annals of neurology.

[10]  H. Kinney,et al.  Volumetric brain differences in children with periventricular T2-signal hyperintensities: a grouping by gestational age at birth. , 2001, AJR. American journal of roentgenology.

[11]  Giovanni Cioni,et al.  Early Cognitive and Communication Development in Children With Focal Brain Lesions , 2001, Journal of child neurology.

[12]  Joan Stiles,et al.  The development of drawing in children with congenital focal brain injury: Evidence for limited functional recovery , 1997, Neuropsychologia.

[13]  M. Järvelin,et al.  Psychological Findings in Preterm Children Related to Neurologic Status and Magnetic Resonance Imaging , 1998, Pediatrics.

[14]  M. Moseley,et al.  Diffusion tensor brain imaging findings at term-equivalent age may predict neurologic abnormalities in low birth weight preterm infants. , 2003, AJNR. American journal of neuroradiology.

[15]  H. W. Andersson,et al.  Cerebral magnetic resonance imaging and mental and motor function of very low birth weight children at six years of age. , 1997, Neuropediatrics.

[16]  S. Chapman,et al.  Discourse plasticity in children after stroke: age at injury and lesion effects. , 2003, Pediatric neurology.

[17]  M. Mishkin,et al.  Effects of hemispheric side of injury, age at injury, and presence of seizure disorder on functional ear and hand asymmetries in hemiplegic children , 1996, Neuropsychologia.

[18]  P. Huttenlocher,et al.  FACTORS AFFECTING COGNITIVE FUNCTIONING OF HEMIPLEGIC CHILDREN , 1987, Developmental medicine and child neurology.

[19]  G. Cioni,et al.  Atypical language lateralization and early linguistic development in children with focal brain lesions. , 2005, Developmental medicine and child neurology.

[20]  S. Orcesi,et al.  Neurodevelopmental outcome at 5-7 years in preterm infants with periventricular leukomalacia. , 1994, Neuropediatrics.

[21]  G. Cioni,et al.  Timing and type of congenital brain lesion determine different patterns of language lateralization in hemiplegic children , 2002, Neuropsychologia.

[22]  D. Trauner,et al.  Disparity of Verbal and Performance IQ Following Early Bilateral Brain Damage , 2005, Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology.

[23]  D. Aram,et al.  Limits to a left hemisphere explanation for specific language impairment. , 1994, Journal of speech and hearing research.

[24]  E. Melhem,et al.  Correlation of corpus callosal morphometry with cognitive and motor function in periventricular leukomalacia. , 2003, Neuropediatrics.

[25]  Ralph-Axel Müller,et al.  Functional brain reorganization in children , 1996, Brain and Development.

[26]  D. Delis,et al.  Verbal learning and memory after childhood stroke , 2004, Journal of the International Neuropsychological Society.

[27]  E. Melhem,et al.  Periventricular leukomalacia: relationship between lateral ventricular volume on brain MR images and severity of cognitive and motor impairment. , 2000, Radiology.

[28]  Richard L Robertson,et al.  Late Gestation Cerebellar Growth Is Rapid and Impeded by Premature Birth , 2005, Pediatrics.

[29]  N. Mather.  PERFORMANCE OF LEARNING DISABLED SUBJECTS AND GIFTED SUBJECTS ON THE WOODCOCK-JOHNSON PSYCHO-EDUCATIONAL BATTERY AND THE WECHSLER INTELLIGENCE SCALE FOR CHILDREN--REVISED (WISC-R). , 1984 .

[30]  J. Steichen,et al.  Very-low-birth-weight, Preterm Infants With or Without Intracranial Hemorrhage , 1989, Clinical pediatrics.

[31]  D. Trauner,et al.  Verbal and performance IQ patterns in children after perinatal stroke , 1994 .

[32]  O. Pryds,et al.  Brain lesions in preterms: origin, consequences and compensation , 1999, Acta paediatrica.