A – 41 Neuropsychological Outcome Following Auto-Immune Congenital Heart Block and Pediatric Middle Cerebral Artery Thrombotic Stroke

Abstract Objective Given increasing survival rates in pediatric stroke, practitioners are tasked with treating ongoing motor and neuropsychological sequelae through the course of development. Poststroke, children are at long-term risk of difficulties with executive function, learning, and emotional regulation. This case study examined the neuropsychological profile of a child with a complex history of autoimmune congenital heart block (ACHB), moderate preterm birth, and a large right middle cerebral artery (MCA) thrombotic stroke at age 4. She continues to struggle with left-sided hemiparesis and significant learning and attention difficulties. The child’s mother was diagnosed with Sjogren’s syndrome (i.e., autoimmune disease) during the first trimester of pregnancy. A pacemaker was placed at birth. Method This single-subject design examines a 10-year-old, 5th-grade female referred for neuropsychological assessment secondary to significant cognitive, self-regulatory, and academic difficulties related to her medical history and co-occurring anxiety. Assessment goals included identification of strengths and weaknesses, intervention guidance, educational planning, and family education. Results Assessment results indicated notable challenges in motor skills, learning, executive functioning, and emotional regulation. The subject demonstrated strengths in social motivation, a good sense of humor, and positive interpersonal relationships. Conclusion The subject’s profile revealed features consistent with the literature regarding the specific neuropsychological vulnerabilities following pediatric ischemic stroke. Her presentation, however, is unique and marked by ACHB, a rare predisposing risk factor for thrombotic stroke. This study underscores the importance of recognizing neurologic risk factors and utilization of serial neuropsychological assessment for children following pediatric stroke to ensure access to appropriate interventions, specialized instruction, and family guidance.