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Aim: To examine adjustment after stroke in adolescence from the perspective of affected young people. Method: Fourteen participants (10 female) aged 13 to 25 years with a history of ischemic or hemorrhagic stroke in adolescence participated in one‐on‐one semi‐structured interviews at the Hospital for Sick Children, Toronto, Canada. Interviews were audio‐recorded and transcribed verbatim. Two independent coders conducted a reflexive thematic analysis. Results: Five themes were identified as representative of adjustment after stroke: (1) 'Processing the story'; (2) 'Loss and challenges'; (3) 'I've changed'; (4) 'Keys to recovery'; and (5) 'Adjustment and acceptance'. Interpretation: This qualitative study provides medical professionals with a personal, patient‐driven lens through which to better understand the challenges of adjusting to life after pediatric stroke. Findings highlight the need to provide mental health support to patients to assist them in processing their stroke and adapting to long‐lasting sequelae. What this paper adds: Processing the onset event is a key component of adjustment to stroke.Feelings of anxiety, sadness, frustration, and self‐consciousness impede adjustment to stroke.Young people may feel overwhelmed academically owing to neurocognitive deficits.Sequelae may rid young people of hobbies and passions, and alter plans for the future.To adjust to stroke, survivors draw on resilience, patience, determination, and social support. [ABSTRACT FROM AUTHOR]

Background: Posterior fossa ependymoma (PFE) comprises 2 groups, PF group A (PFA) and PF group B (PFB), with stark differences in outcome. However, to the authors' knowledge, the long‐term outcomes of PFA ependymoma have not been described fully. The objective of the current study was to identify predictors of survival and neurocognitive outcome in a large consecutive cohort of subgrouped patients with PFE over 30 years. Methods: Demographic, survival, and neurocognitive data were collected from consecutive patients diagnosed with PFE from 1985 through 2014 at the Hospital for Sick Children in Toronto, Ontario, Canada. Subgroup was assigned using genome‐wide methylation array and/or immunoreactivity to histone H3 K27 trimethylation (H3K27me3). Results: A total of 72 PFE cases were identified, 89% of which were PFA. There were no disease recurrences noted among patients with PFB. The 10‐year progression‐free survival rate for all patients with PFA was poor at 37.1% (95% confidence interval, 25.9%‐53.1%). Analysis of consecutive 10‐year epochs revealed significant improvements in progression‐free survival and/or overall survival over time. This pertains to the increase in the rate of gross (macroscopic) total resection from 35% to 77% and the use of upfront radiotherapy increasing from 65% to 96% over the observed period and confirmed in a multivariable model. Using a mixed linear model, analysis of longitudinal neuropsychological outcomes restricted to patients with PFA who were treated with focal irradiation demonstrated significant continuous declines in the full‐scale intelligence quotient over time with upfront conformal radiotherapy, even when correcting for hydrocephalus, number of surgeries, and age at diagnosis (‐1.33 ± 0.42 points/year; P = .0042). Conclusions: Data from a molecularly informed large cohort of patients with PFE clearly indicate improved survival over time, related to more aggressive surgery and upfront radiotherapy. However, to the best of the authors' knowledge, the current study is the first, in a subgrouped cohort, to demonstrate that this approach results in reduced neurocognitive outcomes over time. In a subgroup‐specific manner, the results of the current study demonstrate that survival among patients with posterior fossa ependymoma has improved over time, and this improvement clearly is related to a change in practice with regard to pursuing aggressive surgical resections with upfront postoperative radiotherapy in all patients. This significant improvement highlights an urgent need for the implementation of early intervention and neuroprotective strategies. [ABSTRACT FROM AUTHOR]

The article offers information on several people who served at the Hospital for Sick Children in Toronto, Ontario. It mentions that the neurosurgery service of the hospital begun with the appointment of neurosurgeon William S. Keith in 1933. It says that E. Bruce Hendrick joined Keith in 1954 after he had obtained an specialty training in pediatric neurosurgery in Boston, Massachusetts. It states that Harold J. Hoffman was appointed as neurosurgical staff at Sick Kids in 1964.