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Prognosis of ischemic stroke in childhood: a long-term follow-up study
E L De Schryver1, L J Kappelle, A Jennekens-Schinkel
1Department of Child Neurology, University Medical Centre, Utrecht, The Netherlands.
Insights
Long-term outcomes for childhood ischemic stroke show good physical recovery but often require special education. Cognitive function may decline, particularly in children with epilepsy, necessitating ongoing support.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Child Health
Background:
- Limited understanding of long-term physical, cognitive, and quality of life outcomes in pediatric ischemic stroke survivors.
- Childhood ischemic stroke affects development and requires comprehensive long-term assessment.
Purpose of the Study:
- To evaluate long-term physical sequelae, cognitive functioning, and quality of life in children following ischemic stroke.
- To identify factors influencing outcomes and the need for interventions like special education.
Main Methods:
- Retrospective analysis of CT scans for stroke type in 37 pediatric patients (under 16).
- Long-term follow-up (median 7 years) recording mortality, cardiovascular events, and seizures.
- Clinical examinations assessing physical function, cognitive screening, and subjective health perception.
Main Results:
- Good physical prognosis observed, with most survivors showing no or mild impairment (hemiparesis).
- Significant decline in cognitive functioning noted, especially in children with epilepsy; remedial teaching was frequently required.
- High self-reported happiness and health perception among survivors, despite observed behavioral changes and need for special education.
Conclusions:
- Childhood ischemic stroke has a relatively favorable physical prognosis, especially without severe underlying causes.
- Cognitive deficits and the need for special education are common, highlighting the importance of neurodevelopmental monitoring.
- While physical recovery is often positive, long-term cognitive and social adjustments are crucial for pediatric stroke survivors.
Abstract:
Little is known about long-term physical sequelae, cognitive functioning, and quality of life in children who have experienced ischemic stroke. Thirty-seven patients under 16 years of age were studied; the median interval after stroke was 7 years. CT-scans were reassessed to determine the type of infarction at baseline. Occurrences of death, of new cardiovascular events, and of seizures during follow-up were recorded. Surviving patients were invited for a follow-up examination, including physical check-up, global screening of cognition, and an inventory of subjective health perception. Only two patients were lost to follow-up. During follow-up four died, nine developed seizures, eight had transient ischemic attacks, and two experienced a recurrent ischemic stroke. None of the patients had cardiac complications during follow-up. In 11 of 27, no functional impairment was found, in 15 there was a hemiparesis of varying severity, and in one a paraplegia. There was a significant shift in cognitive functioning towards lower levels, especially in children with epilepsy. Remedial teaching was frequently needed. Many of the parents' perceived their child's behavior to be very changeable. Three-quarters of the children considered themselves as healthy as other children, and almost all of them as happy. The physical and functional prognosis after ischemic stroke in childhood is relatively good, particularly in children with no serious causative illness, but special education is often needed and social changes occur.