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. 2019 Oct 11;14(10):e0223584.
doi: 10.1371/journal.pone.0223584. eCollection 2019.

Cerebral Blood Flow Imbalance Is Associated With Motor Outcome After Pediatric Arterial Ischemic Stroke

Free PMC article

Cerebral Blood Flow Imbalance Is Associated With Motor Outcome After Pediatric Arterial Ischemic Stroke

Rebekka Leistner et al. PLoS One. .
Free PMC article


Cerebral hemodynamics after arterial ischemic stroke (AIS) in children are largely unknown. This study aims to explore long-term cerebral perfusion balance of vital tissue and its relation to motor outcome after childhood AIS. Patients diagnosed with childhood AIS (≤16 years at diagnosis, time since stroke ≥2 years) and typically developing peers were examined. Hemiparesis was classified according to the Pediatric Stroke Outcome Measure. Manual ability was assessed using the ABILHAND-Kids questionnaire. Cerebral blood flow was measured by arterial spin labeling and analyzed in the following brain regions: the hemispheres, the territory of the anterior cerebral artery (ACA), the middle cerebral artery (MCA), and in subregions of the MCA territory (MCA anterior, middle, posterior). To assess cerebral perfusion balance, laterality indices were calculated using cerebral blood flow in the ipsi- and contralesional hemisphere. Laterality indices were compared between stroke patients with and without hemiparesis, and peers. Twenty participants diagnosed with AIS were included (12 boys, 8 girls; mean age 14.46±4.96 years; time since stroke 8.08±3.62 years); 9 (45%) were diagnosed with hemiparesis. Additionally, 47 typically developing peers (21 boys, 26 girls; mean age 14.24±5.42 years) were studied. Laterality indices were higher in stroke patients and oriented to the contralesional hemisphere in all brain regions except the ACA territory and MCA posterior subregion. This was significantly different from peers, who showed balanced laterality indices. There was a significant correlation between laterality indices and manual ability, except in the ACA territory. AIS is associated with long-term alterations of cerebral blood flow in vital tissue, even in patients without hemiparesis. The degree of imbalance of cerebral perfusion in children after AIS is associated with manual ability.

Conflict of interest statement

The authors have declared that no competing interests exist.


Fig 1
Fig 1. MRI, ASL perfusion map and analyzed brain regions.
The left panel shows an axial brain MRI, the middle panel an ASL perfusion map with colors indicating the regional cerebral perfusion in ml/100g/min. The right panel shows the analyzed vascular territories of the anterior cerebral artery (ACA), middle cerebral artery (MCA) and subregions (MCA anterior, middle, posterior).
Fig 2
Fig 2. Global cerebral blood flow in peers and stroke patients.
(A) The course of global cerebral blood flow (CBF) with increasing age in male and female peers and (B) in male and female stroke patients. Data points indicate participants; lines are regression curves best fitting the data points.
Fig 3
Fig 3. Cerebral blood flow laterality indices in patients with and without hemiparesis and in peers.
Positive values indicate CBF lateralization to the contralesional hemisphere (and, in peers, to the dominant hemisphere); negative values indicate lateralization to the ipsilesional hemisphere (and, in peers, to the non-dominant hemisphere). Note the positive LIs in patients with and without hemiparesis (except LI ACA CBF), whereas LIs are near 0 in typically developing peers.

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Grant support

This work was supported by the Swiss National Science Foundation (32003B_146894 / 1) and funds from the Anna Mueller Grocholski foundation (Switzerland), Schweizerische Stiftung für das Cerebral Gelähmte Kind (Switzerland) and the Vinetum foundation (Switzerland). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.