Parkinsonism & related disorders · 2026
Prognostic value of acute neuroimaging and clinical factors in pediatric post-pump chorea.
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Liu Ming, Feng Weixing, Tian Xiaojuan, Dai Lifang, Ding Changhong
Аннотация
OBJECTIVE: To evaluate the association between early postoperative neuroimaging findings, clinical characteristics, and long-term clinical outcomes in pediatric post-pump chorea (PPC).
METHODS: We conducted a retrospective, combined cohort study incorporating two institutional PPC cases and 24 literature-derived cases (total n = 26). PPC was defined as chorea onset within one month of cardiac surgery using cardiopulmonary bypass. Outcomes were categorized as good (resolution within 6 months), poor (persistence >6 months), or death. Clinical features and acute-phase neuroimaging (CT/MRI within one month of symptom onset) were compared between outcome groups.
RESULTS: Only five patients (19.2%) achieved complete neurological recovery. Persistent chorea occurred in 15 patients (57.7%), and six deaths were recorded. Older age at onset (10.1 ± 4.0 vs. 2.8 ± 4.3 years; P = 0.002) and longer surgery-to-chorea latency (11.4 ± 6.3 vs. 4.9 ± 3.3 days; P = 0.029) were associated with good outcomes. Cyanotic heart disease was more frequent in the poor-outcome group (100% (15/15) vs. 40.0% (2/5); χ2 = 10.6, P = 0.009). Acute-phase neuroimaging abnormalities were also more prevalent in the poor-outcome group (86.7% (13/15) vs. 20.0% (1/5); χ2 = 12.9, P = 0.048), with basal ganglia lesions (40.0%) and cortical involvement (predominantly atrophy/reduced volume, 46.7%).
CONCLUSION: Younger age at onset, shorter symptom latency, the presence of cyanotic heart disease, and acute neuroimaging abnormalities involving the basal ganglia and cortex are associated with persistent neurological deficits in pediatric PPC and may aid in early risk stratification, although study limitations prevent causal inference.
METHODS: We conducted a retrospective, combined cohort study incorporating two institutional PPC cases and 24 literature-derived cases (total n = 26). PPC was defined as chorea onset within one month of cardiac surgery using cardiopulmonary bypass. Outcomes were categorized as good (resolution within 6 months), poor (persistence >6 months), or death. Clinical features and acute-phase neuroimaging (CT/MRI within one month of symptom onset) were compared between outcome groups.
RESULTS: Only five patients (19.2%) achieved complete neurological recovery. Persistent chorea occurred in 15 patients (57.7%), and six deaths were recorded. Older age at onset (10.1 ± 4.0 vs. 2.8 ± 4.3 years; P = 0.002) and longer surgery-to-chorea latency (11.4 ± 6.3 vs. 4.9 ± 3.3 days; P = 0.029) were associated with good outcomes. Cyanotic heart disease was more frequent in the poor-outcome group (100% (15/15) vs. 40.0% (2/5); χ2 = 10.6, P = 0.009). Acute-phase neuroimaging abnormalities were also more prevalent in the poor-outcome group (86.7% (13/15) vs. 20.0% (1/5); χ2 = 12.9, P = 0.048), with basal ganglia lesions (40.0%) and cortical involvement (predominantly atrophy/reduced volume, 46.7%).
CONCLUSION: Younger age at onset, shorter symptom latency, the presence of cyanotic heart disease, and acute neuroimaging abnormalities involving the basal ganglia and cortex are associated with persistent neurological deficits in pediatric PPC and may aid in early risk stratification, although study limitations prevent causal inference.