Differences in risk-factors, aetiology and outcome between children and young adults with acute ischaemic stroke (original) (raw)

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.