Cerebrovascular reactivity and intellectual outcome in childhood stroke with transient cerebral arteriopathy

Publication date: Available online 7 January 2017
Source:Pediatric Neurology
Author(s): Nomazulu Dlamini, Ivanna Yau, Robyn Westmacott, Manohar Shroff, Derek Armstrong, William Logan, David Mikulis, Gabrielle deVeber, Andrea Kassner
BackgroundHypercapnic-challenge blood oxygen level-dependent MRI 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 (AIS), transient cerebral arteriopathy (TCA) is a frequent, non-progressive 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 non-progressive stenosis using CVR and intellectual outcome.ObjectiveWe hypothesized that children with TCA and chronic non-progressive intracranial artery stenosis have impaired CVR distal to the stenosis and associated cognitive impairment.MethodsWe studied children with a prior diagnosis of TCA as defined by infarction limited to the basal ganglia and/or internal capsule and significant (>50% diameter) residual stenosis of the supraclinoid internal carotid artery and/or its proximal branches. All children had CVR, intellectual function and infarct volumes quantified.ResultsWe performed CVR studies in five children at mean 8.96 years (3.33 – 14.58 years) post-stroke. Impaired CVR was limited to the infarct zone and adjacent white matter in the majority of children. Intellectual function was broadly average in all but one subject.ConclusionIn 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.



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