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Published on: April 21, 2017
Outcome of arterial ischemic stroke in children with heart disease
María Vázquez López1, Pedro de Castro de Castro1, Estibaliz Barredo Valderrama1
1Department of Neuropaediatrics, H.G.U Gregorio Marañón, Madrid, Spain.
Insights
Pediatric arterial ischemic stroke (AIS) in children with heart disease leads to poor outcomes, including sensorimotor and cognitive impairments. Early stroke and epilepsy are linked to worse prognoses, highlighting the need for targeted interventions.
Area of Science:
- Pediatric neurology
- Pediatric cardiology
- Neuroscience
Background:
- Arterial ischemic stroke (AIS) is uncommon in children, but congenital and acquired heart diseases are significant risk factors.
- Children with heart conditions face a higher risk of stroke, necessitating a deeper understanding of outcomes and prognostic factors.
Purpose of the Study:
- To investigate the long-term outcomes of children with heart disease who experienced AIS.
- To identify factors influencing the prognosis of pediatric AIS in this vulnerable population.
Main Methods:
- Retrospective evaluation of children with heart disease and AIS between 2000 and 2014.
- Assessment of outcomes using the Pediatric Stroke Outcome Scale (PSOS) and modified Rankin scale (mRS).
Main Results:
- 74 children with heart disease suffered AIS; 20% mortality and 10% recurrent stroke rate observed.
- Most survivors (52 evaluated) experienced sensorimotor and cognitive-behavioral impairments at a 6-year follow-up.
- Factors associated with poor prognosis included neonatal stroke, larger stroke size, cortical/subcortical involvement, basal ganglia lesions, fever, hemiparesis, and epilepsy; normal EEG correlated with better outcomes.
Conclusions:
- Pediatric AIS in children with heart disease is associated with significant long-term disability across multiple domains.
- Epilepsy affects one-third of these patients, underscoring the neurological sequelae of stroke in this group.
Abstract:
Arterial ischemic strokes (AIS) are rare in childhood. Congenital and acquired heart diseases are one of the most important risk factors of AIS in children.
Objective:
Study the outcome of children with heart disease that have suffered AIS and the factors that influence on prognosis.
Patients And Methods:
We evaluated all children with heart disease who had suffered AIS between 2000 and 2014 in our hospital.
Results:
Seventy-four children with heart disease suffered an arterial ischemic stroke. 20% of them died and 10% had new AIS during the study period. Fifty-two patients were evaluated an average of six years after AIS. According to the Paediatric Stroke Outcome Scale (PSOM), most of the patients had some degree of impairment, mainly in sensorimotor and in cognitive-behavioural areas. The modified Rankin scale (mRS) showed an unfavourable outcome in 70% of patients (including patients that have died). Upper limb was more functionally impaired than lower limb. Strokes in neonatal period and early life were associated with poor prognosis. Size of stroke, cortical and subcortical involvement and basal ganglia stroke were associated with an unfavourable outcome. Fever in the acute phase and hemiparesis at presentation were also poor prognostic factors. Epilepsy at time of evaluation was also associated with unfavourable outcome. On the other hand, a normal electroencephalogram was associated with favourable outcome.
Conclusions:
AIS in children with heart disease had an unfavourable outcome, with impairment in different areas. Epilepsy happened in one third of the patients.
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