Age-associated hippocampal volume changes in childhood arterial ischemic stroke

PurposeRecent evidence suggests that recovery from secondary neurodegeneration following arterial ischemic stroke (AIS) may be related to age at injury and site of occlusion. We conducted a study of hippocampal volume (HCV) in a cohort of pediatric patients with middle cerebral artery (MCA) territory AIS to determine whether HCV would be preserved in younger children as compared to older children.MethodsThis single-center, HIPAA-compliant retrospective study was approved by the institutional review board. The medical records of 149 children treated for AIS between 2000 and 2016 were reviewed for inclusion criteria: unilateral MCA territory AIS and availability of high-resolution T1-weighted MR imaging at both acute and chronic time periods. Manual segmentation was utilized to measure stroke-side HCV, contralateral HCV, hemispheric volumes, and stroke volume on each scan. To correct for variable brain size, HCV measurements were ratio normalized. Patients were divided into two age-at-stroke groups: younger (30days-9years old) and older (>9-18years old). Analysis was performed using Fisher's test or Student's t test.ResultsThe MR imaging of 19 children (9 younger, 10 older) was analyzed. At follow-up, the average stroke-side HCV increased by 10.9% in the younger group and decreased by 6.3% in the older group (P=0.010); this between-group difference remained significant even when ratio normalized (P=0.003). The total brain volume-adjusted acute stroke size between groups was not statistically different (P=0.649).ConclusionsIn children with AIS, younger age is associated with the relative preservation of HCV, which could reflect differences in age-related plasticity.