Etiologic Profile of Childhood Stroke from North India: Is It Different from Developed World?
Abhinandan Sood1, Renu Suthar1, Jitendra K Sahu1
1Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Childhood arterial-ischemic stroke in this developing country cohort is often linked to arteriopathies, particularly infection-related ones. Most survivors experience significant neurologic deficits within three months, highlighting the need for targeted interventions.
Area of Science:
- Neurology
- Pediatrics
- Epidemiology
Background:
- Childhood arterial-ischemic stroke (AIS) presents unique etiological profiles in developing nations.
- Understanding these specific risk factors is crucial for effective prevention and management.
Purpose of the Study:
- To investigate the causes of pediatric AIS in a developing country.
- To evaluate the short-term neurological outcomes for affected children.
Main Methods:
- A prospective observational study enrolled 76 children (age >28 days to <12 years) with AIS.
- Neurological outcomes were assessed using the Pediatric Cerebral Performance Category (PCPC) and Pediatric Stroke Outcome Measure (PSOM) scales at 3 months.
Main Results:
- Arteriopathy was the leading cause (77%), with infection-associated arteriopathies (42%), mineralizing angiopathy (13%), and moyamoya disease (13%) being most common.
- Among survivors, 61% had sensory-motor deficits, and 39% had severe neurologic disability (PCPC ≥ 4).
- Fever, encephalopathy, low Glasgow coma score, seizures, and infection-associated arteriopathy predicted poor outcomes.
Conclusions:
- Pediatric AIS etiology differs significantly from developed countries, with infection-related arteriopathies being prominent.
- A substantial proportion of pediatric stroke survivors face long-term neurologic disability.
Objective:
To describe the etiology of childhood arterial-ischemic stroke from a developing country and assess short-term neurologic outcome.
Methods:
Prospective observational study. Consecutive children between the age of >28 days to <12 years, admitted with the diagnosis of arterial-ischemic stroke were enrolled during the study period from January 2017 to December 2018. Short-term neurologic outcome was assessed with Pediatric Cerebral Performance Category (PCPC) scale and Pediatric Stroke Outcome Measure (PSOM).
Results:
We enrolled 76 children with arterial-ischemic stroke, with a median age of 24 months (interquartile range 12-69), and 43 (57%) were boys. The most common risk factor for childhood arterial-ischemic stroke was arteriopathy in 59 (77%), followed by cardiovascular disorder in 12 (16%) children. Among 59 children with arteriopathy, 32 (42%) had infection-associated arteriopathies, 10 (13%) had mineralizing angiopathy, 10 (13%) had moyamoya disease. Pediatric stroke risk factors were classified according to Pediatric Stroke Classification and CASCADE primary classification. Short-term neurologic outcome was assessed at 3 months in 62 (82%) survivors. Among stroke survivors, 33 (61%) had sensory-motor deficits, and 24 (39%) had severe neurologic disability (PCPC ≥ 4). The presence of fever, encephalopathy, low Glasgow coma score at presentation, seizures, and infection-associated arteriopathy predicted severe neurologic disability at follow-up.
Conclusion:
The risk factors for pediatric arterial-ischemic stroke are different from developed countries in our cohort. Infection-associated arteriopathies, mineralizing angiopathy, and moyamoya disease are the most common risk factors in our cohort. Two-thirds of pediatric stroke survivors have neurologic disability at short-term follow-up.
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