Long-Term Negative Impact of Pediatric Stroke on Language

Background/Purpose: To investigate the long-term language outcome in a group of children with postnatally acquired unilateral strokes in comparison to children with perinatally acquired unilateral strokes and typically developing controls, and the influence of possible modifiers in terms of timing and lesion characteristics.

Methods: We examined 9 patients (3 females, median age = 13.5 years, range: 8–27 years, 6 left-sided) with postnatal stroke, 23 patients with perinatal stroke (11 females, median age = 12.5 years, range 8–26 years, 16 left-sided), and 33 matched typically developing individuals (15 females, median age = 12.33, range: 8–29 years). Language outcome was assessed with age-appropriate scales of the Potsdam Illinois Test of Psycholinguistic Abilities (P-ITPA) and the Peabody Picture Vocabulary Test (PPVT), nonverbal intelligence with the Test of Nonverbal Intelligence (TONI-4), language lateralization with functional MRI, and lesion size with MRI-based volumetry.

Results: All four patients who had initially presented with aphasia acquired by postnatal stroke had recovered. Patients with postnatal strokes scored significantly lower than the control group (ANCOVA, mean corrected language score post = −0.30, peri = −0.38, control = 0.419), but similar to patients with perinatal strokes, after correcting for general intelligence.

In patients with postnatal strokes, none of the possibly modifying factors, including lesion side, correlated significantly with language outcome.

Group differences in language performances. Both patient groups scored significantly lower than the control group (mean corrected language score POST = −0.299, mean corrected language score PERI = −0.378, mean corrected language score CONTROL = 0.410).

Conclusion: Children and adolescents usually “fully recover” from aphasia, but in contrast to perinatal stroke, postnatal stroke can lead to chronic language deficits, regardless of the affected hemisphere. The rehabilitation of children and adolescents with postnatal stroke should address language abilities, even after the usually quick resolution of clear aphasic symptoms.