Long-term outcome after arterial ischemic stroke in children and young adults (original) (raw)
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Developmental medicine and child neurology, 2015
Stroke in children occurs across different phases of brain development. Age at onset may affect outcome and health-related quality of life (HRQL). We evaluated the influence of age at stroke onset on the long-term neurological outcomes and HRQL of pediatric stroke survivors. Children with ischemic stroke were recruited into three groups according to their age at onset of stroke (presumed perinatal, neonatal, and childhood). Neurological outcomes were assessed using the Pediatric Stroke Recovery and Recurrence Questionnaire. HRQL was evaluated using proxy report versions (2-18y) of the Pediatric Quality of Life Inventory (PedsQL 4.0). A χ(2) /Fisher's exact test and multivariable logistic regression analysis was performed for the neurological outcomes. HRQL scores from the different age groups were compared using linear regression. Ninety participants (presumed perinatal stroke, n=31; neonatal stroke, n=36; childhood stroke, n=23) were enrolled. Median age at the onset of stroke ...
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.
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.
Outcome after ischaemic stroke in childhood
Developmental Medicine & Child Neurology, 2000
A parental questionnaire was used to investigate the outcome for children who had had ischaemic stroke, who were seen at Great Ormond Street Hospital, London between 1990 and. The results of functional assessments carried out by a physiotherapist and an occupational therapist, and of quantitative evaluations carried out by a neuropsychologist were used for validation where possible. The relationship between clinical and radiological factors and outcome were examined. The children were aged between 3 months and 15 years at the time of stroke (median age 5 years) and the period of follow-up ranged from 3 months to 13 years (median duration 3 years). Of the 90 children for whom data were obtained, 13 (14%) had no residual impairments. Outcome was good in 37 children (40%) and poor in 53 (60%) (defined according to whether impairments interfered with daily life). Agreement, as measured by Cohen's kappa, was good or very good between the parents' responses and the qualitative measures provided by the medical professionals and the therapists, but only fair to moderate for the quantitative measures provided by the neuropsychologists. This may reflect different parental perceptions of the physical and cognitive aspects of outcome. Younger age at time of the stroke was the only significant predictor of adverse outcome.
Risk factors and treatment outcomes for children with arterial ischemic stroke
Journal of Clinical Neuroscience, 2010
To investigate the risk factors and treatment outcomes for ischemic stroke in children, we reviewed the charts of 93 children with ischemic stroke seen at our hospital between 1997 and 2006. Age at stroke, sex, medical history, family history, clinical findings upon admission, history of seizure, and radiological findings were recorded. Mean age at onset of the initial stroke was 56.6 ± 46.9 months, ranging from 1 month to 14 years. The male:female ratio was 1.6:1. Cardiac and infectious disease were the most common risk factors (37.7%). There were five children (5.4%) who had recurrent stroke and three (3.2%) who had multiple risk factors. Cardiac and infectious causes appeared to be the most important risk factors for ischemic stroke in children in the Adana region of Turkey.
Stroke, 1994
Information about the long-term prognosis of young adults with ischemic stroke is limited. Therefore, we performed a follow-up assessment of 296 patients with ischemic stroke who are enrolled in the Iowa Registry of Stroke in Young Adults. We studied young adults (age, 15 to 45 years) who were referred to a tertiary medical center for management of ischemic stroke between July 1, 1977, and January 1, 1992. Follow-up assessments were performed by means of questionnaires, examinations, telephone interviews, review of medical records, and reports from personal physicians. Data about risk factors, coincident medical diseases, etiology of stroke, treatment, recurrent stroke, other vascular events, and deaths were collected. Outcomes were rated with the Glasgow Outcome Scale, Barthel Index, National Institutes of Health stroke scale, and the Mini-Mental State Examination. Quality of life was assessed with the SF-36 Health Status questionnaire. Follow-up information about the status of 10 ...
Stroke, 2011
Background and Purpose— Stroke is an important cause of death and disability among children. Clinical trials for childhood stroke require a valid and reliable acute clinical stroke scale. We evaluated interrater reliability (IRR) of a pediatric adaptation of the National Institutes of Health Stroke Scale. Methods— The pediatric adaptation of the National Institutes of Health Stroke Scale was developed by pediatric and adult stroke experts by modifying each item of the adult National Institutes of Health Stroke Scale for children, retaining all examination items and scoring ranges of the National Institutes of Health Stroke Scale. Children 2 to 18 years of age with acute arterial ischemic stroke were enrolled in a prospective cohort study from 15 North American sites from January 2007 to October 2009. Examiners were child neurologists certified in the adult National Institutes of Health Stroke Scale. Each subject was examined daily for 7 days or until discharge. A subset of patients ...