Neurocognitive Outcomes Following Childhood Intracerebral Hemorrhage

Claire Champigny, The Hospital for Sick Children, Toronto, Canada
Leila Kahnami, York University, Toronto, Canada
Tamiko Isaacs, York University, Toronto, Canada
Nataly Beribisky, York University, Toronto, Canada
Mary Desrocher, York University, Toronto, Canada
Samantha Feldman, York University, Toronto, Canada
Pradeep Krishnan, the Hospital for Sick Children, Toronto, Canada
Nomazulu Dlamini, the Hospital for Sick Children, Toronto, Canada
Peter Dirks, the Hospital for Sick Children, Toronto, Canada
Robyn Westmacott, the Hospital for Sick Children, Toronto, Canada


Neurocognitive deficits commonly occur following intracerebral hemorrhage (ICH) in childhood and can impact many neuropsychological domains. The current study explores patterns and trends in neurocognitive outcomes following childhood ICH. The objectives are to describe neurocognitive outcomes relative to population norms and to examine predictors of outcome. 

Participants and Methods:

17 patients (52.9% female, M age=14.22, SD=4.59) with a history of childhood ICH (age at injury 4-16 years, M=10.64, SD=3.88) completed a neuropsychological assessment evaluating functioning across multiple neurocognitive domains (i.e., perceptual reasoning, verbal reasoning, processing speed, working memory, learning, memory, visuo-motor integration, selective attention) as well as a global measure of full-scale IQ. Caregivers completed a standardized questionnaire evaluating executive functioning. Descriptive statistics illustrated trends and patterns across neuropsychological scores as compared to population norms. Simple linear regressions examined associations between FSIQ and three predictor variables selected from a priori hypotheses: age at time of stroke, which was calculated based on chart review; lesion volume, which was coded using radiological findings, following guidelines of Beslow’s Pediatric Intracerebral Hemorrhage Score; and family household income, which was reported by caregivers on a 6-point scale ranging from < $25,000 to > $150,000. 


Mean FSIQ in this sample fell within the clinically average range (i.e., standard score of 90-110). Out of 17 participants, 4 participants (23.53%) had an FSIQ >1SD below the mean, which is consistent with population norms. However, participants’ mean scores fell below the clinically average range in three of the nine neurocognitive domains assessed: learning, memory, and visuo-motor integration. On measures assessing verbal learning and memory, 10/17 (58.8%) participants performed >1SD below the mean. On a task of visuo-motor integration, 6/17 (35.29%) performed >1SD below the mean. Age at stroke, lesion volume, and household income were individually not found to be statistically significantly associated with FSIQ (p>.05). A clinically meaningful trend was noted regarding the association between FSIQ scores and lesion volume; participants with a medium-sized lesion scored nearly 1.5 SD lower than those with a small lesion (b=-13.89). 


Findings suggest that neuropsychological test batteries focusing on core neurocognitive domains may not fully capture neurocognitive deficits in this population. Although survivors of childhood ICH may generally present with FSIQ within the average range, they may experience pointed deficits in select neurocognitive domains. Clinical examination of a wide range of skills, including those related to learning, memory, and visuo-motor integration, is warranted. The current study provides clinically applicable information that can help inform neuropsychological test batteries for patients with childhood ICH, manage family expectations regarding neurocognitive outcomes, and guide rehabilitation and academic recommendations. 

Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Child)

Keyword 1: brain injury
Keyword 2: neurocognition
Keyword 3: pediatric neuropsychology