Understanding the Neuropsychologic Outcome of Pediatric AVM Within a Neurodevelopmental Framework

Abstract

This case series describes the long-term neuropsychologic functioning of 5 children with repaired arteriovenous malformations (AVMs). Results are presented within the context of a neurodevelopmental model to facilitate conceptualization and generate appropriate rehabilitation strategies for children with AVMs. The current case series expands upon previous research examining the long-term psychosocial functioning of these children with AVMs in which it was found that overall emotional functioning appeared adequate, although there were suggestions of defensiveness and areas of worry. In addition, global adaptive functioning was below average for most children with parental concerns about their child's socialization. Five children with repaired AVMs in the cerebellum and frontal, temporal, and parietal lobes participated in a neuropsychologic evaluation assessing intellectual, language, memory, motor, visual-perceptual and visual-motor, and executive functions. These children demonstrated both localized and remote findings. More specifically, mild to moderate weaknesses in executive functions were suggested regardless of AVM location. The finding that children exhibited executive function difficulties regardless of AVM location is in keeping with the understanding of multiple cortical and subcortical pathways to and from the frontal lobes. In addition, it is possible that the processes of diaschisis and plasticity may play a role in the functional outcome of AVMs.