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Presentation, clinical course, and outcome of childhood stroke
M J Lanska1, D J Lanska, S J Horwitz
1Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
Insights
Pediatric unilateral hemispheric stroke presents differently based on age at diagnosis. Early-onset strokes often lead to later- εμφανής hemiparesis, while later-onset strokes cause immediate motor deficits and variable outcomes.
Area of Science:
- Neurology
- Pediatrics
- Neuroscience
Background:
- Unilateral hemispheric stroke in children is a significant cause of long-term neurological disability.
- Understanding the varied presentations and outcomes is crucial for timely diagnosis and intervention.
Purpose of the Study:
- To analyze the clinical presentations, developmental trajectories, and long-term outcomes of pediatric unilateral hemispheric stroke.
- To correlate the age of stroke identification with clinical manifestations and functional results.
Main Methods:
- Retrospective review of 42 children diagnosed with unilateral hemispheric stroke.
- Analysis of clinical data including age at stroke onset, presenting symptoms, neurological examination findings, and long-term follow-up outcomes.
Main Results:
- Infants with early-onset strokes (first days of life) often presented with seizures and later developed hemiparesis.
- Children with strokes later in infancy typically showed early hand preference without a clear ictus, with motor deficits becoming more apparent over time.
- Older children usually presented with sudden hemiparesis and seizures, with initial severity followed by some motor improvement.
- All children were ambulatory at follow-up, though some had persistent hemiparesis. 19% experienced recurrent seizures.
Conclusions:
- The age at which unilateral hemispheric stroke is identified significantly influences its clinical presentation and the apparent progression of neurological deficits in children.
- While functional outcomes like ambulation are often achieved, hemiparesis and epilepsy can persist, highlighting the need for ongoing management.
Abstract:
We reviewed the presentations, clinical courses, and outcomes of 42 children with unilateral hemispheric stroke. Infants with strokes identified within the first few days of life usually presented with seizures. These infants had few abnormal neurologic findings as neonates, but hemiparesis became evident as gross motor development proceeded. Infants with strokes identified later in the first year of life usually presented with pathologic early hand preference without a history of an ictus. During subsequent development, the motor deficits in these children became more evident, producing an apparent progression of the neurologic abnormalities. Strokes identified in older children typically presented as sudden hemiparesis, often associated with seizures. The hemiparesis in these children was most severe at the onset, followed by some improvement in strength in all patients. Functional outcome was variable. At last follow-up, all children were ambulatory, some with clinically apparent hemiparesis. Eight of the 42 children (19%) developed recurrent seizures with an onset ranging from 4 months to more than 10 years (median: 26 months) after the stroke.