Predictors of neurocognitive outcome following childhood hemorrhagic stroke in the left hemisphere: A case series

Neurocognitive deficits commonly occur following hemorrhagic stroke in childhood, yet the understanding of recovery patterns and prognostic factors remains limited. Hematoma location, lateralization, volume, and age at injury have been identified as predictors of neurocognitive outcomes. This case review aims to describe and discuss the influence of these factors on neurocognitive outcomes following hemorrhagic stroke in three pediatric cases. Three patients (one female age 13, two males ages 15 and 17) with a history of childhood hemorrhage were selected from a larger cohort due to their similar etiology (i.e., arteriovenous malformation) and similar lesion location (i.e., broadly within the temporoparietal region). Participants completed a neuropsychological assessment evaluating verbal comprehension, perceptual reasoning, processing speed, working memory, verbal fluency, language, learning, memory, and executive functioning. Results suggest variable language outcomes despite similar clinical characteristics. Both Case 1 and Case 2, who had medium-sized hematomas, exhibited challenges with verbal learning, verbal memory, word finding, and word generation. In contrast, Case 3, who had a small-sized hematoma, showed broadly preserved verbal abilities. All three cases exhibited challenges on at least one measure of executive functioning. The distinct performance of the three cases highlights the complexity of predicting neurocognitive abilities following childhood left hemisphere hemorrhagic stroke. The finding that all cases exhibited executive functioning deficits suggests an area of vulnerability in this population. Clinical implications include the importance of close monitoring and follow-up through comprehensive neuropsychological assessment in this population.