Is Asymmetry of the Pons Associated with Hand Function and Manual Ability after Arterial Ischemic Stroke in Children?

AIM: This study was designed to investigate how the asymmetry of the brain stem is related to hand function and manual ability after arterial ischemic stroke (AIS) diagnosed during childhood. METHOD: Patients diagnosed with AIS during childhood (> 5 years old, diagnosis > 2 years before recruitment) and typically developing peers were recruited by the Swiss Neuropediatric Stroke Registry. Brainstem cross-sectional areas of each side at the level of the pons were measured. Pinch and grip strength were measured with a dynamometer, quality of upper limb movement by the Melbourne Assessment 2 and manual ability by the ABILHAND-kids. An asymmetry index was calculated for all measures (except the ABILHAND-kids). Differences between groups and correlations were calculated using nonparametric statistics. RESULTS: Fourteen AIS survivors without hemiparesis, 10 AIS survivors with hemiparesis, and 47 typically developing peers were assessed. Patients with hemiparesis showed the highest brainstem asymmetry. There was a significant positive correlation between brainstem asymmetry, the asymmetry of strength and quality of upper limb movement, and a significant negative correlation between brainstem asymmetry and manual ability. INTERPRETATION: In pediatric AIS survivors, brainstem asymmetry can serve as an indirect measure of corticospinal tract integrity. It is significantly correlated with strength, quality of movement, and manual ability.