The utility of infarct volume measurement in pediatric ischemic stroke

Area of Science:

• Pediatric Neurology
• Neuroradiology
• Stroke Medicine

Background:

• Acute arterial ischemic stroke (AAIS) in children presents unique challenges in predicting neurologic outcomes.
• Diffusion-weighted imaging (DWI) is a key tool for assessing infarct size in acute stroke.
• Identifying reliable prognostic markers is crucial for optimizing management strategies in pediatric stroke.

Purpose of the Study:

• To investigate the association between stroke volume measured by DWI and neurologic outcomes in pediatric patients with AAIS.
• To determine if infarct size, as a percentage of total brain volume, predicts functional recovery.
• To explore the role of clinical characteristics, such as seizures, in conjunction with stroke volume for outcome prediction.

Main Methods:

• A cohort of pediatric patients diagnosed with AAIS at a tertiary care children's hospital was retrospectively studied.
• Stroke volume was quantified using DWI, expressed as a percentage of total brain volume.
• Neurologic outcome was assessed using the Glasgow Outcome Scale (GOS).

Main Results:

• Children with poor neurologic outcomes exhibited a larger median infarct volume on DWI compared to those with good outcomes.
• A stroke volume exceeding 10% of total brain volume was significantly associated with a higher likelihood of poor outcome.
• Seizures were identified as an independent risk factor, increasing the risk of poor outcome by 10.5-fold.

Conclusions:

• Stroke volume on DWI is a significant predictor of neurologic outcome in pediatric acute arterial ischemic stroke.
• Combining stroke volume measurements with clinical factors like seizures can enhance the identification of children requiring aggressive management.
• These findings support the use of DWI-derived stroke volume in clinical decision-making for pediatric stroke patients.