Neuropsychologic Outcomes in a Case Series of Twins Discordant for Perinatal Stroke

Perinatal stroke may affect cognitive development, but few studies have addressed the details of cognitive function after perinatal stroke. The present study was designed to compare the neuropsychologic features of five sets of twins discordant for perinatal stroke. All of the affected children had unilateral middle cerebral artery infarction (two left, three right); four of the five infarcts were large-branch, affecting the entire M1 territory. Three of the five affected children had comorbid epilepsy. Measures of intelligence, memory, language, attention, executive function, visual-motor integration, and fine motor skills were administered to children at a median age of 5 years (range, 5-8 years). Relative to their unaffected co-twins, the twins with perinatal stroke exhibited lower levels of full scale ( p = 0.005), verbal ( p = 0.006), and nonverbal ( p = 0.005) intelligence. Children with perinatal stroke also showed significant deficits on tests of verbal memory ( p = 0.041), receptive language ( p = 0.011), verbal fluency ( p = 0.019), and visual attention ( p = 0.011), compared with their unaffected co-twins. Twin gestation may be a risk factor for poor cognitive outcome after perinatal stroke. Large infarct size and comorbid epilepsy may have contributed to some of the poor cognitive outcomes in this cohort.