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Published on: August 18, 2015
Presentation of Acute Childhood Stroke in a Tertiary Pediatric Emergency Department
Adriana Yock-Corrales, Flory Varela-Bulgarelli1, Cary Barboza1
1Cardiology Department, and.
Insights
Pediatric stroke in developing countries mirrors developed nations in diagnosis and risk factors, despite delays in care. Long-term deficits affect over a third of young stroke patients.
Area of Science:
- Neurology
- Pediatrics
- Global Health
Background:
- Stroke is a significant cause of morbidity and mortality in children.
- Understanding the clinical spectrum, management, and outcomes of pediatric stroke in developing countries is crucial for improving care.
Purpose of the Study:
- To describe the clinical presentation, management, and outcomes of acute stroke in children presenting to a tertiary emergency department in a developing country.
- To compare findings with published series from developed countries.
Main Methods:
- Retrospective case series of pediatric patients (1 month to 18 years) with radiologically confirmed acute stroke over a 7-year period.
- Data collection included clinical presentation, neuroimaging, risk factors, management, and outcomes.
- Statistical analysis of demographic, clinical, and radiological data.
Main Results:
- Ninety-five pediatric stroke cases were analyzed, with hemorrhagic stroke (48.5%), arterial ischemic stroke (42.8%), and sinus venous thrombosis (8.5%) being the main diagnoses.
- Common risk factors included congenital cardiac disease (9%).
- Significant delays in presentation to the emergency department (median 24 hours for AIS and HS, 120 hours for SVT) were observed, with 36% requiring intensive care and 36% experiencing long-term deficits.
Conclusions:
- The spectrum of pediatric stroke in this developing country is similar to that reported in developed countries regarding diagnosis, risk factors, and delayed presentation.
- No tropical diseases were identified as risk factors.
- Delayed presentation, neuroimaging, and long-term neurodeficits highlight the need for improved stroke care infrastructure and awareness in developing regions.
Objectives:
The aim was to describe clinical presentation, management, and outcomes of stroke in a tertiary emergency department (ED) of a developing country.
Methodology:
Retrospective case series of patients aged 1 month to 18 years presenting to an ED with radiological confirmed acute stroke during a 7-year period were studied.
Results:
Ninety-five patients were identified. Twenty-five patients were excluded because of incomplete records (8) or not presenting via ED (17). Thirty-four (48.5%) were diagnosed with hemorrhagic stroke (HS), 30 (42.8%) with arterial ischemic stroke (AIS), and 6 (8.5%) with sinus venous thrombosis (SVT). Mean age was 5.3 years, and 55.3% were male. The median time from onset of symptoms to ED presentation was 24 hours (mean, 55 hours; interquartile range [IQR], 14-72) for AIS, 24 hours (mean, 46.9 hours; IQR, 9-48) for HS, and 120 hours (mean,112 hours; IQR, 72-168) for SVT. Congenital cardiac disease was the most common risk factor (9%). For AIS, the most common symptoms were focal numbness 56.6% (95% confidence interval [CI], 37.8%-75.4%), focal weakness 56.6% (95% CI, 37.8%-75.4%), and seizures 50% (95% CI, 31%-68.8%). For HS, the most common symptoms were headache 64.7% (95% CI, 47.7%-81.6%), vomiting 79.4 (95% CI, 65-93.7), and altered mental status 64.7% (95% CI, 47.7-81.6). Computed tomography scan was done in 100% of the patients and magnetic resonance imaging in 54%. Twenty-five (36%) patients were admitted to intensive care unit and required intubation. Long-term deficit was identified in 24 (36%) patients based on medium-term follow-up.
Conclusions:
The spectrum of stroke in a developing country was similar to published series from developed countries in terms of final diagnosis, risk factors, and delay to ED presentation, neuroimaging, and long-term neurodeficits. No tropical diseases were identified as risk factors.
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