Could infarct location predict the long-term functional outcome in childhood arterial ischemic stroke? (original) (raw)
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Children, 2021
Arterial ischemic stroke (AIS) in children is a rare condition; its frequency is estimated at 0.58 to 7.9 new onsets in 100,000 children per year. The knowledge on risk factors, clinical outcomes and consequences of pediatric AIS is increasing. However, there are still many unknowns in the field. The aim of the study was to analyze the clinical presentation of pediatric AIS and its consequences according to the neuroimaging results and location of ischemia. The research was retrospective and observational. The analyzed group consisted of 75 AIS children (32 girls, 43 boys), whereby the age of the patients ranged from 9 months to 18 years at stroke onset. All the patients were diagnosed and treated in one tertiary center. The most frequent stroke subtype was total anterior circulation infarct (TACI) with most common ischemic focus location in temporal lobe and vascular pathology in middle cerebral artery (MCA). The location of ischemic focus in the brain correlated with post-stroke o...
Modified Pediatric ASPECTS Correlates with Infarct Volume in Childhood Arterial Ischemic Stroke
Frontiers in Neurology, 2012
Background and Purpose: Larger infarct volume as a percent of supratentorial brain volume (SBV) predicts poor outcome and hemorrhagic transformation in childhood arterial ischemic stroke (AIS). In perinatal AIS, higher scores on a modified pediatric version of the Alberta Stroke Program Early CT Score using acute MRI (modASPECTS) predict later seizure occurrence. The objectives were to establish the relationship of modASPECTS to infarct volume in perinatal and childhood AIS and to establish the interrater reliability of the score. Methods:We performed a cross sectional study of 31 neonates and 40 children identified from a tertiary care center stroke registry with supratentorial AIS and acute MRI with diffusion weighted imaging (DWI) andT2 axial sequences. Infarct volume was expressed as a percent of SBV using computer-assisted manual segmentation tracings. ModASPECTS was performed on DWI by three independent raters. The modASPECTS were compared among raters and to infarct volume as a percent of SBV. Results: ModASPECTS correlated well with infarct volume. Spearman rank correlation coefficients (ρ) for the perinatal and childhood groups were 0.76, p < 0.001 and 0.69, p < 0.001, respectively. Excluding one perinatal and two childhood subjects with multifocal punctate ischemia without large or medium sized vessel stroke, ρ for the perinatal and childhood groups were 0.87, p < 0.001 and 0.80, p < 0.001, respectively. The intraclass correlation coefficients for the three raters for the neonates and children were 0.93 [95% confidence interval (CI) 0.89-0.97, p < 0.001] and 0.94 (95% CI 0.91-0.97, p < 0.001), respectively. Conclusion: The modified pediatric ASPECTS on acute MRI can be used to estimate infarct volume as a percent of SBV with a high degree of validity and interrater reliability.
Long-term outcome after arterial ischemic stroke in children and young adults
Neurology, 2015
OBJECTIVE To compare long-term outcome of children and young adults with arterial ischemic stroke (AIS) from 2 large registries. METHODS Prospective cohort study comparing functional and psychosocial long-term outcome (2 years after AIS) in patients who had AIS during childhood (1 month-16 years) or young adulthood (16.1-45 years) between January 2000 and December 2008, who consented to follow-up. Data of children were collected prospectively in the Swiss Neuropediatric Stroke Registry, young adults in the Bernese stroke database. RESULTS Follow-up information was available in 95/116 children and 154/187 young adults. Median follow-up of survivors was 6.9 years (interquartile range 4.7-9.4) and did not differ between the groups (p = 0.122). Long-term functional outcome was similar (p = 0.896): 53 (56%) children and 84 (55%) young adults had a favorable outcome (modified Rankin Scale 0-1). Mortality in children was 14% (13/95) and in young adults 7% (11/154) (p = 0.121) and recurrence rate did not differ (p = 0.759). Overall psychosocial impairment and quality of life did not differ, except for more behavioral problems among children (13% vs 5%, p = 0.040) and more frequent reports of an impact of AIS on everyday life among adults (27% vs 64%, p < 0.001). In a multivariate regression analysis, low Pediatric NIH Stroke Scale/NIH Stroke Scale score was the most important predictor of favorable outcome (p < 0.001). CONCLUSION There were no major differences in long-term outcome after AIS in children and young adults for mortality, disability, quality of life, psychological, or social variables.
Neuropediatrics, 2010
Objective: The aim of this study was to compare children and young adults with acute ischemic stroke (AIS) in 2 large registries. Methods: We compared clinical characteristics, stroke etiology, workup, and outcome (modified Rankin scale score [mRS] at 3-6 months) in children (1 month-16 years) and young adults (16.1-45 years) with AIS. Data of children were collected prospectively in the nationwide Swiss NeuroPediatric Stroke Registry, young adults in the Bernese stroke database. Outcome (mRS) and stroke severity (pediatric adaptation of the National Institutes of Health stroke scale [PedNIHSS]) in children were calculated retrospectively. Results: From January 2000 to December 2008, 128 children and 199 young adults suffered from an AIS. Children were more likely to be male than young adults (62%/49%, p ¼ 0.023) and less frequently had hypertension (p ¼ 0.001), hypercholesterolemia (p ¼ 0.003), and a family history of stroke (p ¼ 0.048). Stroke severity was similar in children and young adults (median PedNIHSS/NIHSS 5/6; p ¼ 0.102). Stroke etiology (original TOAST classification) was more likely to be ''other determined cause'' in children than in young adults (51%/29%; p < .001). Cervicocerebral artery dissections were less frequent in children than in young adults (10%/23%; p ¼ 0.005). Outcome at 3 to 6 months did not differ between children and young adults (p ¼ 0.907); 59% of children and 60% of young adults had a favorable outcome (mRS 0-1). Mortality was similar among children and young adults (4%/6%; p ¼ 0.436). In multivariate analysis, low PedNIHSS/NIHSS was the most important predictor of favorable outcome (p < 0.001). Interpretation: Although stroke etiology and risk factors in children and young adults are different, stroke severity and clinical outcome were similar in both groups. ANN NEUROL 2011;70:245-254 C hildhood acute ischemic stroke (AIS) is increasingly recognized as an important cause of morbidity and is among the top 10 causes of death in children. 1 Previous studies showed that AIS in children and young adults has different etiologies. Unlike stroke in adults, which is mainly caused by atherosclerosis and thromboembolism, pathogenesis of AIS in childhood is poorly understood, and many disorders have been associated with childhood AIS, although there is increasing evidence that nonatherosclerotic arteriopathies (in the majority, focal transient arteriopathies) are the most common risk factor for childhood stroke. In addition, outcome of AIS in children is generally considered more favorable than in adults, given the better plasticity of the brain in children. However, this assumption is challenged by several studies showing that more than half of survivors of childhood AIS have long-term physical disabilities and cognitive impairment. Studies comparing children and young adults with AIS are limited. Two previous comparisons showed View this article online at wileyonlinelibrary.com.
Acute ischemic stroke: Relationship of brain lesion location & functional outcome
Disability and rehabilitation, 2009
Purpose. To establish, using brain spiral computerised tomography (SCT) and modified Barthel index (MBI), whether the location of cerebral infarction could be correlated with functional outcome in acute ischemic stroke patients who undergo early intensive rehabilitation. Methods. Observational cohort, assessor blinded and correlational prospective 12-weeks study that included 111 acute ischemic stroke patients, admitted consecutively to an early intensive inpatient rehabilitation programme (5 days a week, 3-5 h a day) during 2003. Confirmation of diagnosis and stratification was done by brain SCT. Brain lesion locations were correlated to motor performance and functional outcome, on admission and discharge, using MBI. Results. Statistical analysis demonstrated a significant correlation between motor performance, functional outcome and brain lesion locations. The groups with deep, combined deep and large superficial, small superficial and large superficial infarcts showed the most consistent improvement in that order of frequency. Normal brain SCT group did not reach statistical significance (p ¼ 0.051) while the bi-hemispheric infarcts group did not show any change. The inter and intra group differences were highly significant (p 5 0.05). Conclusions. Immediate non-contrasted brain SCT may act as an independent predictor of final functional outcome in acute ischemic stroke. It may provide clinicians with an opportunity to offer realistic expectations to stroke patients and their relatives.
2018
Objective was to study etiological factors, clinical features, neuroradiological findings, Outcome in infants and children who present with ischemic stroke.Study design: It was a descriptive study.Setting: It was a hospital based study which was conducted in the Children Hospital, Pakistan Institute of Medical Sciences from 1st August 2002 to 30th December 2003.Method: In this study children were included who presented with weakness, altered sensorium, seizures, or any focal deficit. CT brain was done in all these children. Those having evidence of infarct were studied for clinical features, etiological factors and out come. Those having neurological infection, trauma, brain tumor, and abscess were excluded from the study. For data analysis, SPSS 8 software was used.Results: Total of studied thirty patients were enrolled in the study. Age range was from two month to twelve years. Male to female ratio was 3.3 to 1. Sixteen (53%) were 6-12 years of age while 12 (40%) were 2-5 years ag...
Short-term neurological outcomes in ischemic and hemorrhagic pediatric stroke
Pediatrics International, 2018
Background: Our aim is to retrospectively assess short-term neurological outcomes in pediatric stroke with patient features. Methods:Children aged 28 days-18 years with arterial ischemic stroke (AIS), cerebral sinovenous thrombosis (CSVT), and hemorrhagic stroke (HS) between 2007 and 2013 were evaluated. Neurological findings within the first three months were accepted as short-term prognosis and modified Rankin scale was used. Results: In the study, 33 patients (62%) with AIS, 12 (23%) with HS, and 8 (15%) with CSVT were included. Moya moya syndrome was the most common new diagnosis in AIS. Stroke recurred in 5 (15%), one AIS patient with posterior circulation infarct died (3%). Prognosis in AIS was favorable for 20 patients (61%) and poor for 13 patients (39%). Fourty two percent of HS were of vascular origin. Seven patients (70%) with HS had good prognosis and 3 (30%) patients had poor prognosis with no death. Homocysteine related hypercoagulability was most frequently detected in the etiology CSVT. Synchronous systemic thrombosis was observed in 3 (37.5%) and death occurred in two (25%) CSVT patients. Prognosis was evaluated as favorable for 3 (37.5%) and poor for 5 of CSVT patients (62.5%). For thrombophilia, thrombosis panel was performed fully in 83% of AIS and CSVT patients. Conclusions: Pediatric stroke is associated with poor prognosis in a substantial number of patients in short term, with CSVT having the worst prognosis. Not only ischemic but also hemorrhagic stroke were presented with detailed patient characteristics, with a full thrombosis panel achieved for most ischemic stroke patients.
Paediatric arterial ischaemic stroke: functional outcome and risk factors
Developmental Medicine and Child Neurology, 2010
Health-related quality of life MCA Middle cerebral artery mRS Modified Rankin Scale PAIS Paediatric arterial ischaemic stroke QOL Quality of life TAPQOL QOL questionnaire for parents of children aged 1-6y TACQOL-PF QOL questionnaire for children aged 6-15y, parent form TACQOL-CF QOL questionnaire for children aged 8-15y, child form TAAQOL QOL questionnaire for adolescents aged ‡16y TNO-AZL AIM To study functional outcome in children aged 1 month to 18 years after paediatric arterial ischaemic stroke (PAIS) and to identify risk factors influencing their quality of life. METHOD In a consecutive series of 76 children (35 males 41 females, median age at diagnosis 2y 6mo, range 1mo-17y 2mo; median length of follow-up 2y 4mo, range [7mo-10y 6mo]) with PAIS diagnosed at the Erasmus Medical Centre Sophia Children's Hospital between 1997 and 2006, we collected clinical, biochemical, and radiological data prospectively. In 66 children surviving at least 1 year after PAIS, functional outcome could be evaluated with the World Health Organization's International Classification of Impairments, Disabilities and Handicaps.