Abstract W MP109: Childhood Cerebral Sinovenous Thrombosis (CSVT): Long-Term Neuropsychological Outcomes

Abstract

Background: Outcome from childhood CSVT particularly in infants is poor. Most studies report “general” neurological outcomes; few describe neuropsychological outcomes specifically. Objectives: To study the spectrum of neuropsychological deficits following childhood CSVT. Methods: Retrospective review of clinical data [incl pediatric stroke outcome measure (PSOM)] & neuropsychological testing (NPT) from 1995-2011 was conducted. NPT included IQ [Wechsler Intelligence Score for Children (WISC-IV), Wechsler Preschool & Primary Scale of intelligence (WPPSI-III)], executive function [Behaviour Rating Inventory of Executive Function (BRIEF)] & attention [Test of everyday attention for children (Tea-Ch)]. Full scale IQ (FSIQ) included verbal comprehension (VCI), perceptual reasoning (PRI), working memory (WMI) & processing speed (PSI) index. Results: NPT was performed in 48/206 subjects. 41 (34 males) were analyzed [excl: cavernous sinus thrombosis (5), prematurity (1), concurrent arterial stroke (1)]. Mean age at NPT: 5.4-y (neonatal CSVT) and 8.5-y (non-neonatal CSVT; mean time from CSVT to NPT 2.4-y). NPT was abnormal (atleast 1SD below mean) in 87% patients in one (29%) or multiple (58%) tests. FSIQ was abnormal in 64% [VCI-69%, PRI-80%, WMI-71%, PSI-79%). Compared to normative population, patients scored significantly lower on FSIQ (p=0.026), VCI (p=0.608), PRI (p= 0.032), WMI (0.124) and PSI (p=0.007). No significant difference was seen in FSIQ between groups [neonates/non-neonates (p=0.827), single/multiple sinus (p=0.2), present/absent parenchymal lesions (p=0.991)]. However males scored significantly lower on FSIQ (p=0.006), PRI (p=0.004), WMI (p=0.002)& PSI (p=0.002)] but not on VCI (0.69)]. BRIEF [metacognition (p=0.061) & executive composite (p=0.095)] & Tea-Ch (p=0.046) scores were also poorer in males. Mean cognitive/behaviour sphere score (max 2.0) of PSOM (assessed closest to NPT) was worse in males (0.41) than females (0.14). Conclusions: Majority of childhood CSVT survivors (males > females) have detectable cognitive deficits on detailed NPT on long term follow-up. NPT is useful in accurate assessment of CSVT outcome & could guide academic interventions. Larger studies are needed to replicate these findings.