Cerebrovascular Reactivity and Intellectual Outcome in Childhood Stroke With Transient Cerebral Arteriopathy

• Published in: Pediatric neurology 2017-04, Vol.69, p.71-78
• Main Authors: Dlamini, Nomazulu, MD, PhD, Yau, Ivanna, MN, NP, Westmacott, Robyn, PhD, C Psych, Shroff, Manohar, MD, Armstrong, Derek, MD, Logan, William, MD, Mikulis, David, MD, deVeber, Gabrielle, MD, Kassner, Andrea, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; arteriopathy; Brain - blood supply; Brain - diagnostic imaging; Brain - physiopathology; Cerebral Angiography; Cerebral Arterial Diseases - diagnostic imaging; Cerebral Arterial Diseases - physiopathology; Cerebral Arterial Diseases - psychology; Cerebrovascular Circulation - physiology; cerebrovascular reactivity; Child; Constriction, Pathologic - diagnostic imaging; Constriction, Pathologic - physiopathology; Constriction, Pathologic - psychology; CVR; Female; Humans; Imaging, Three-Dimensional; Intelligence; Magnetic Resonance Imaging; Male; Neurology; neuropsychology; outcome; Oxygen - blood; Pediatrics; stroke; Stroke - diagnostic imaging; Stroke - physiopathology; Stroke - psychology; transient cerebral arteriopathy
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2017.01.001

Abstract Background Hypercapnic-challenge blood oxygen level–dependent magnetic resonance imaging cerebrovascular reactivity (CVR), measures the regional perfusion response to altered carbon dioxide. CVR correlates with the tissue-level microvascular dysfunction and ischemic risk. Among children with arterial ischemic stroke, transient cerebral arteriopathy (TCA) is a frequent, nonprogressive unilateral intracranial arteriopathy, which typically results in basal ganglia infarction and chronic cerebral artery stenosis. Therefore TCA provides a model for studying the consequences of chronic nonprogressive stenosis using CVR and intellectual outcome. We hypothesized that children with TCA and chronic nonprogressive intracranial artery stenosis have impaired CVR distal to the stenosis and associated cognitive impairment. Methods We studied children with a prior diagnosis of TCA as defined by infarction limited to the basal ganglia, internal capsule, or both; and significant (greater than 50% diameter) residual stenosis of the supraclinoid internal carotid artery, its proximal branches or both. All children had CVR, intellectual function, and infarct volumes quantified. Results We performed CVR studies in five children at mean 8.96 years (3.33 to 14.58 years) poststroke. Impaired CVR was limited to the infarct zone and adjacent white matter in most children. Intellectual function was broadly average in all but one subject. Conclusions In children with typical TCA, ipsilateral cortical CVR and intellectual function seem to be preserved despite persistent arterial stenosis in the majority. These findings suggest that chronic revascularization strategies in these children may not be indicated and require further exploration in a larger cohort of children.