Cognitive Outcomes in Pediatric Arteriovenous Malformation with Cerebral Hemorrhage: A Case Series

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Background: Arteriovenous malformation (AVM) is a leading cause of pediatric hemorrhagic stroke. While immediate management and short-term outcomes have been well-documented, research on long-term cognitive recovery after AVM hemorrhage remains limited, and outcomes are often difficult to predict. Methods: We report the long-term cognitive recovery outcomes of 20 pediatric cases (12 boys, 8 girls) who underwent rehabilitation and cognitive function assessments during the recovery phase at our center following acute treatment for intracranial hemorrhage due to AVM. The mean age at onset was 11.0 ± 3.1 years (range: 6.3–16.6 years). The primary outcome was resumption of the premorbid educational trajectory, and we evaluated its relationship with the initial Full-Scale IQ (FIQ) recorded after onset. Results: Motor recovery was favorable (90% achieved independent walking), but cognitive outcomes were generally poor, with 60% exhibiting persistent dysfunction. Eight patients (40%) resumed their premorbid educational trajectory. Of the 8 patients whose FIQ reached 80 or above within the first 6 months post-onset, 6 (75%) subsequently resumed that trajectory, compared with 2 of the 12 patients whose early FIQ remained below 80 (odds ratio 15.0, 95% CI 1.65–136.2, p = 0.019; sensitivity 75%, specificity 83%). A normal-range FIQ was necessary but not sufficient: all 8 patients who resumed their premorbid trajectory reached an FIQ ≥ 80, yet 4 of the 12 patients who reached an FIQ ≥ 80 did not resume it. Conclusions: Although FIQ continued to improve for years in many patients, late gains were rarely sufficient to reach the normal range when the early assessment was low. Cognitive status in the early recovery phase was therefore associated with long-term educational continuity, and assessment within the first 6 months post-onset may inform planning without awaiting prolonged spontaneous recovery.

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