A cognitive and affective pattern in posterior fossa strokes in children: a case series.
OBJECTIVE
Posterior fossa strokes account for about 10% of ischaemic strokes in children. Although motor and dysautonomic symptoms are common, to our knowledge cognitive and affective deficits have not been described in the paediatric literature. Our aim, therefore, was to describe these symptoms and deficits.


METHODS
In a retrospective study, we included all cases of posterior fossa strokes in children occurring at a single centre between 2005 and 2007, and investigated cognitive and affective deficits.


RESULTS
Five males aged 3 to 14 years met the inclusion criteria. They all presented very early with mood disturbances: outbursts of laughter and/or crying and alternating agitation or prostration that disappeared spontaneously within a few days. Persistent cognitive deficits were also diagnosed in all five: initial mutism, then anomia, followed by comprehension deficiency and deficiencies of planning ability, visual-spatial organization, and attention. Despite early and intensive rehabilitation, recovery from these cognitive deficits was slow and sometimes incomplete, and on follow-up they proved to be more disabling than the motor symptoms.


CONCLUSIONS
These findings are similar to the cerebellar cognitive affective syndrome described in adults, and quite similar to the language and affective deficits observed in children after surgery for posterior fossa tumour. This is consistent with the role of the cerebellum and brainstem in affective and cognitive processes from early development.
Kossorotoff
Manoelle
M
Paediatric Neurology Department, Hôpital Necker-Enfants Malades, APHP, 149 rue de Sévres, Paris, France. manoelle.kossorotoff@nck.aphp.fr
Gonin-Flambois
Coralie
C
Gitiaux
Cyril
C
Quijano
Susana
S
Boddaert
Nathalie
N
Bahi-Buisson
Nadia
N
Barnerias
Christine
C
Dulac
Olivier
O
Brunelle
Francis
F
Desguerre
Isabelle
I
D000293:Adolescent; D000339:Affect; D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications*; D018450:Disease Progression; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019964:Mood Disorders / Q000150:complications*; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000473:pathology