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[Ischemic stroke in children--a diagnostic challenge]
1Barneklinikken Rikshospitalet 0027 Oslo. alf.bjornstad@rikshospitalet.no
Insights
Childhood ischemic strokes, though uncommon, present with varied motor symptoms. Infections and cardiac issues are leading causes, with many children experiencing long-term disabilities or recurrent strokes.
Area of Science:
- Pediatric Neurology
- Cerebrovascular Diseases
- Childhood Stroke Etiologies
Context:
- Ischemic cerebral infarctions are rare in children, with distinct causes compared to adults.
- This study analyzed 22 children aged 3 months to 13 years experiencing ischemic strokes between 1994 and 1999.
Purpose:
- To present clinical findings, investigations, and outcomes of pediatric ischemic strokes.
- To identify common etiologies and sequelae in this age group.
- To propose diagnostic and treatment strategies for childhood stroke.
Summary:
- Motor deficits like hemiplegia and facial palsy were predominant symptoms.
- Infections and cardiac diseases/procedures were the most frequent causes (22% each).
- Outcomes included complete recovery (27%), varying degrees of disability (41% mild, 18% moderate, 14% severe), and recurrent strokes (18%).
Impact:
- Highlights the importance of thorough evaluation for identifying recurrence risks.
- Informs diagnostic approaches and treatment strategies for acute cerebrovascular disease in children.
- Contributes to understanding the unique aspects of pediatric stroke.
Background, Material And Methods:
Ischaemic cerebral infarctions are relatively uncommon in childhood, and the aetiologies seen in this age group are different from those commonly seen in adults. This study presents clinical findings, investigation results and outcome in a five-year material collected between 1994 and 1999 in our department. It includes 22 children with ischaemic strokes aged three months to 13 year at the first or only stroke episode.
Results:
The symptoms caused by ischaemic strokes in this age group vary and are often combined. Motor symptoms dominate, and we found hemiplegia, facial palsy, visual disturbances and reduced consciousness, listed according to decreasing occurrence. Infections and cardiac diseases or procedures were the most common aetiologies, both occurring with 22%. Other groups were autoimmune diseases (14%), malignancies (5%) and dissection of the a. carotis after trauma (5%). None of the patients in this material died as a result of the ischaemic stroke; 27% recovered completely. 41% had light sequela, 18% moderate sequela, and 14% ended up severely disabled. 18% had recurrent stroke episodes.
Interpretation:
Appropriate examination after stroke in childhood is of great importance, since some of the aetiologies are associated with recurrence risk. Based on our clinical experiences and literature studies, we suggest a plan for diagnostic evaluation and treatment strategies for children who undergo an acute cerebral vascular disease.