Neurologic Outcome Predictors in Pediatric Intracerebral Hemorrhage: A Prospective Study.

Background And Purpose: Intracerebral hemorrhage is a considerable source of morbidity and mortality. This 3-center study describes outcomes of pediatric intracerebral hemorrhage and identifies 2-year neurological outcome predictors.

Methods: Children 29 days to 18 years of age presenting with intracerebral hemorrhage from March 2007 to May 2015 were enrolled prospectively.

Frequency of hematoma expansion after spontaneous intracerebral hemorrhage in children.

Importance: Hematoma expansion is the only modifiable predictor of outcome in adult intracerebral hemorrhage; however, the frequency and clinical significance of hematoma expansion after childhood intracerebral hemorrhage are unknown.

Objective: To assess the frequency and extent of hematoma expansion in children with nontraumatic intracerebral hemorrhage.

Design, Setting, And Participants: Prospective observational cohort study at 3 tertiary care pediatric hospitals.

Pediatric intracerebral hemorrhage score: a simple grading scale for intracerebral hemorrhage in children.

Background And Purpose: The intracerebral hemorrhage (ICH) score is the most commonly used clinical grading scale for outcome prediction after adult ICH. We created a similar scale in children to inform clinical care and assist in clinical research.

Methods: Children, full-term newborns to 18 years, with spontaneous ICH were prospectively enrolled from 2007 to 2012 at 3 centers.

Natural history and prognostic value of corticospinal tract Wallerian degeneration in intracerebral hemorrhage.

Background: The purpose of this study was to define the incidence, imaging characteristics, natural history, and prognostic implication of corticospinal tract Wallerian degeneration (CST-WD) in spontaneous intracerebral hemorrhage (ICH) using serial MR imaging.

Methods And Results: Consecutive ICH patients with supratentorial ICH prospectively underwent serial MRIs at 2, 7, 14, and 21 days. MRIs were analyzed by independent raters for the presence and topographical distribution of CST-WD on diffusion-weighted imaging (DWI).

Yield of CT perfusion for the evaluation of transient ischaemic attack.

Background: Magnetic resonance diffusion-weighted imaging and perfusion-weighted imaging are able to identify ischaemic 'footprints' in transient ischaemic attack. Computed tomography perfusion (CTP) may be useful for patient triage and subsequent management. To date, less than 100 cases have been reported, and none have compared computed tomography perfusion to perfusion-weighted imaging (PWI).

Arterial spin labeling imaging findings in transient ischemic attack patients: comparison with diffusion- and bolus perfusion-weighted imaging.

Background: Since transient ischemic attacks (TIAs) can predict future stroke, it is important to distinguish true vascular events from non-vascular etiologies. Arterial spin labeling (ASL) is a non-contrast magnetic resonance (MR) method that is sensitive to cerebral perfusion and arterial arrival delays. Due to its high sensitivity to minor perfusion alterations, we hypothesized that ASL abnormalities would be identified frequently in TIA patients, and could therefore help increase clinicians' confidence in the diagnosis.

Disentangling the neuroanatomical correlates of perseveration from unilateral spatial neglect.

Perseverative behavior, manifest as re-cancelling or re-visiting targets, is distinct from spatial neglect. Perseveration is thought to reflect frontal or parietal lobe dysfunction, but the neuroanatomical correlates remain poorly defined and the interplay between neglect and perseveration is incompletely understood. We enrolled 87 consecutive patients with diffusion-weighted, perfusion-weighted imaging, and spatial neglect testing within 24 hours of right hemisphere ischemic stroke.

Automated perfusion imaging for the evaluation of transient ischemic attack.

Background And Purpose: Diffusion-weighted imaging (DWI) is recommended for the evaluation of transient ischemic attack. Perfusion imaging can increase the yield of MRI in transient ischemic attack. We evaluated automated bolus perfusion (the time when the residue function reaches its maximum [TMax] and mean transit time [MTT]) and arterial spin labeling (ASL) sequences for the detection of ischemic lesions in patients with transient ischemic attack.

Evaluation of intraventricular hemorrhage in pediatric intracerebral hemorrhage.

Previous studies of pediatric intracerebral hemorrhage have investigated isolated intraparenchymal hemorrhage. The authors investigated whether detailed assessment of intraventricular hemorrhage enhanced outcome prediction after intracerebral hemorrhage. They prospectively enrolled 46 children, full-term to 17 years, median age 2.

MRI profile of the perihematomal region in acute intracerebral hemorrhage.

Background And Purpose: The pathophysiology of the presumed perihematomal edema immediately surrounding an acute intracerebral hemorrhage is poorly understood, and its composition may influence clinical outcome. Method-Twenty-three patients from the Diagnostic Accuracy of MRI in Spontaneous intracerebral Hemorrhage (DASH) study were prospectively enrolled and studied with MRI. Perfusion-weighted imaging, diffusion-weighted imaging, and fluid-attenuated inversion recovery sequences were coregistered.

ABC/2: estimating intracerebral haemorrhage volume and total brain volume, and predicting outcome in children.

Aim: Few data exist to aid the clinician in prognosis after paediatric intracerebral haemorrhages (ICHs). Recently, ICH volume as a per cent of total brain volume (TBV) was shown to help predict outcomes in children. Thus, we sought to develop a bedside method of TBV estimation using typical hospital imaging software, and to validate the ABC/2 method for children in order to determine ICH volume and aid prognosis.

Recovery from spatial neglect and hemiplegia in a child despite a large anterior circulation stroke and Wallerian degeneration.

Prognosis after stroke in children is difficult given the paucity of literature regarding motor and cognitive recovery. Spatial neglect has been described in children after stroke, yet little evidence exists to guide clinicians and parents regarding its resolution. Wallerian degeneration on magnetic resonance imaging (MRI) suggests poor recovery in neonates and adults.

Intracerebral hemorrhage volume predicts poor neurologic outcome in children.

Background And Purpose: Although intracerebral hemorrhage (ICH) volume and location are important predictors of outcome in adults, few data exist in children.

Methods: A consecutive cohort of children, including full-term newborns to those younger than 18 years of age with nontraumatic, acute ICH and head CT available for analysis were studied. Clinical information was abstracted via chart review.

The NIHSS-plus: improving cognitive assessment with the NIHSS.

Background: The National Institutes of Health Stroke Scale (NIHSS) has been criticized for limited representation of cognitive dysfunction and bias towards dominant hemisphere functions. Patients may therefore receive a low NIHSS score despite a fairly large stroke. A broader scale including simple cognitive tests would improve the clinical and research utility of the NIHSS.

Where (in the brain) do semantic errors come from?

Background: Semantic errors result from the disruption of access either to semantics or to lexical representations. One way to determine the origins of these errors is to evaluate comprehension of words that elicit semantic errors in naming. We hypothesized that in acute stroke there are different brain regions where dysfunction results in semantic errors in both naming and comprehension versus those with semantic errors in oral naming alone.

Hemispherectomy sustained before adulthood does not cause persistent hemispatial neglect.

Introduction: Hemispatial neglect has been well established in adults following acute ischemic stroke, but has rarely been investigated in children and young adults following brain injury. It is known that young brains have a tremendous potential for reorganization; however, there is controversy as to whether functions are assumed by the opposite hemisphere, or perilesional areas in the same hemisphere. Patients with intractable epilepsy who undergo hemispherectomy for treatment are missing the entire cortex on one side following surgery.

Neural substrates of visuospatial processing in distinct reference frames: evidence from unilateral spatial neglect.

There is evidence for different levels of visuospatial processing with their own frames of reference: viewer-centered, stimulus-centered, and object-centered. The neural locus of these levels can be explored by examining lesion location in subjects with unilateral spatial neglect (USN) manifest in these reference frames. Most studies regarding the neural locus of USN have treated it as a homogenous syndrome, resulting in conflicting results.

Supratentorial regions of acute ischemia associated with clinically important swallowing disorders: a pilot study.

Background And Purpose: Dysphagia is a common problem after stroke associated with significant morbidity and mortality. Except for patients with brain stem strokes, particularly lateral medullary strokes, it is difficult to predict which cases are likely to develop swallowing dysfunction based on their neuroimaging. Clear models of swallowing control and integration of cortico-bulbar input have not been defined and the role of subcortical structures is unclear.

Gender differences in unilateral spatial neglect within 24 hours of ischemic stroke.

Hemispatial neglect is a common and disabling consequence of stroke. Previous reports examining the relationship between gender and the incidence of unilateral spatial neglect (USN) have included either a large numbers of patients with few neglect tests or small numbers of patients with multiple tests. To determine if USN was more common and/or severe in men or women, we examined a large group of patients (312 right-handed) within 24 hours of acute right hemisphere ischemic stroke.

Speech and language functions that require a functioning Broca's area.

A number of previous studies have indicated that Broca's area has an important role in understanding and producing syntactically complex sentences and other language functions. If Broca's area is critical for these functions, then either infarction of Broca's area or temporary hypoperfusion within this region should cause impairment of these functions, at least while the neural tissue is dysfunctional. The opportunity to identify the language functions that depend on Broca's area in a particular individual was provided by a patient with hyperacute stroke who showed selective hypoperfusion, with minimal infarct, in Broca's area, and acutely impaired production of grammatical sentences, comprehension of semantically reversible (but not non-reversible) sentences, spelling, and motor planning of speech articulation.

Capgras syndrome and unilateral spatial neglect in nonconvulsive status epilepticus.

Nonconvulsive status epilepticus can manifest as personality changes and psychosis. We report an 87-year-old right-handed male presenting with both Capgras syndrome and severe unilateral spatial neglect during nonconvulsive status epilepticus. After treatment of his seizures, his Capgras syndrome and hemispatial neglect resolved.

The right hand draws the trees, but the left draws the forest?

Spatial processing is lateralized: the right hemisphere is optimized for perceiving global aspects of space ("seeing the forest"), while the left hemisphere specializes in perceiving local aspects of space ("seeing the trees"). However, less is known about how the information is shared across the hemispheres and which areas within the corpus callosum are required for transferring and integrating visuospatial information. Here, we report a 60 year old woman with a mass lesion in the splenium of the corpus callosum who demonstrated visuospatial processing deficits that were out-of-proportion to the rest of her neurological examination.