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Stroke in children: the coexistence of multiple risk factors predicts poor outcome
S Lanthier1, L Carmant, M David
1Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Québec, Canada.
Insights
Multiple risk factors increase the likelihood of recurrent ischemic stroke in children, which is associated with higher mortality rates. Comprehensive investigations are recommended for pediatric ischemic stroke cases.
Area of Science:
- Pediatric Neurology
- Cerebrovascular Diseases
- Stroke Etiology
Background:
- Stroke in children, though less common than in adults, carries significant morbidity and mortality.
- Identifying risk factors is crucial for predicting recurrence and improving outcomes in pediatric stroke patients.
Purpose of the Study:
- To characterize the risk factors associated with pediatric stroke.
- To examine the relationship between identified risk factors and stroke outcomes, including recurrence and mortality.
Main Methods:
- Retrospective chart review of pediatric patients diagnosed with ischemic or hemorrhagic stroke.
- Data collection spanned from 1991 to 1997 at Hopital Sainte-Justine, Montreal.
- Analysis focused on risk factor identification, stroke recurrence, and patient outcomes.
Main Results:
- 51 ischemic strokes were identified, with arterial causes predominating (46 cases).
- Multiple risk factors were present in 24% of ischemic strokes and were significantly associated with higher recurrence rates (42% vs. 8%, p=0.01).
- 21 hemorrhagic strokes were noted, primarily due to vascular abnormalities; multiple risk factors were not observed in this group. Overall mortality was 20%, with recurrent strokes having a higher fatality rate (40%).
Conclusions:
- Multiple risk factors are significant predictors of recurrence in pediatric ischemic stroke.
- Recurrent strokes are associated with an increased risk of mortality.
- Complete etiological investigations, including hematologic, metabolic, and angiographic studies, are warranted for all children with ischemic stroke.
Objective:
To characterize the risk factors for stroke in children and their relationship to outcomes.
Methods:
We reviewed charts of children with ischemic and hemorrhagic stroke seen at Hopital Sainte-Justine, Montreal between 1991 and 1997.
Results:
We found 51 ischemic strokes: 46 arterial and 5 sinovenous thromboses. Risk factors were variable and multiple in 12 (24%) of the 51 ischemic strokes. Ischemic stroke recurred in 3 (8%) patients with a single or no identified risk factor and in 5 (42%) of 12 patients with multiple risk factors (p = 0.01). We also found 21 hemorrhagic strokes, 14 (67%) of which were caused by vascular abnormalities. No patient with hemorrhagic stroke had multiple risk factors. Hemorrhagic stroke recurred in two patients (10%). Outcome in all 72 stroke patients was as follows: asymptomatic, 36%; symptomatic epilepsy or persistent neurologic deficit, 45%; and death, 20%. Death occurred more frequently in patients with recurrent stroke (40%) than in those with nonrecurrent stroke (16%).
Conclusions:
Multiple risk factors are found in many ischemic strokes and may predict stroke recurrence. Recurrent stroke tends to increase rate of mortality. Because of the high prevalence and importance of multiple risk factors, a complete investigation, including hematologic and metabolic studies and angiography, should be considered in every child with ischemic stroke, even when a cause is known.