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Stroke in childhood: outcome and recurrence risk by mechanism in 59 patients
S Chabrier1, B Husson, P Lasjaunias
1Service de Pédiatrie et Génétique, Hôpital Nord, Saint-Etienne, France. sylane@club-internet.fr
Insights
Identifying the cause of childhood stroke is crucial. Understanding the stroke mechanism significantly impacts patient outcomes, recurrence risk, and treatment strategies for pediatric cerebral arterial infarction.
Area of Science:
- Pediatric Neurology
- Cerebrovascular Diseases
- Stroke Pathophysiology
Background:
- Cerebral arterial infarction in children is a significant concern.
- Understanding the underlying mechanisms is key to effective management.
Purpose of the Study:
- To investigate the mechanisms of stroke in a cohort of pediatric patients.
- To correlate stroke mechanisms with patient outcomes and recurrence rates.
Main Methods:
- Consecutive case series of 59 pediatric patients (3 months to 16 years) with cerebral arterial infarction.
- Detailed pathophysiologic evaluation to determine stroke mechanisms.
- Analysis of outcomes and recurrence based on identified mechanisms.
Main Results:
- The stroke mechanism was established in 78% of patients.
- Arteriopathic stroke was most common (53%), including dissection (20%) and transient cerebral arteriopathy (25%).
- Favorable outcomes were higher in nonprogressive arterial disease (70%) compared to embolic stroke, systemic disease, or moyamoya (26%).
Conclusions:
- Determining the mechanism of childhood stroke is critical for predicting outcomes and guiding treatment.
- Different stroke mechanisms have distinct prognoses and recurrence risks in pediatric populations.
Abstract:
This paper describes 59 patients, 3 months to 16 years of age, who were seen consecutively in the same center for cerebral arterial infarction. It focuses on the mechanism of stroke. The pathophysiologic process could be established for 78% of the children. Arteriopathic stroke (31 patients, or 53%) was the most common. The arteriopathies were either progressive (moyamoya in 4 patients, or 7%) or nonprogressive (27 patients, or 46%). The latter form occurred in two patterns: dissection of cervicocephalic arteries (12 patients, or 20%) and transient cerebral arteriopathy of unknown origin but probably angiitis (15 patients, or 25%). Cardiac or transcardiac embolic stroke occurred in 12% of the series and systemic diseases in 14%. There was a favorable outcome in 70% of patients having stroke due to nonprogressive arterial disease and stroke due to unidentified mechanisms. In contrast, only 26% of patients with embolic stroke, systemic disease, or moyamoya had a favorable outcome. Recurrences were more frequent and severe in this latter group. It is concluded that it is important to determine the mechanism of childhood stroke, because it strongly influences outcome, the recurrence risk, and treatment choice.