Related Experiment Video
Updated: Jul 29, 2026
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Pediatric vs. adult stroke: comparative study in a tertiary referral hospital, Cairo, Egypt
Ramy Alloush1, Nahed Salah Eldin1, Hala El-Khawas1
1Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Insights
Pediatric stroke has different causes than adult stroke, often involving non-atherosclerotic conditions and multiple risk factors. Early vascular imaging and thrombophilia evaluation are crucial for diagnosing childhood stroke.
Area of Science:
- Neurology
- Pediatrics
- Vascular Medicine
Background:
- Stroke in children, though rare, carries severe consequences and differs significantly from adult strokes in risk factors and presentation.
- Unlike adults with atherosclerosis, pediatric stroke causes are diverse, including cardiac disorders, infections, prothrombotic conditions, and moyamoya disease/syndrome.
Purpose of the Study:
- To compare the characteristics, clinical features, etiology, subtypes, and diagnostic workup of pediatric and adult strokes.
- To identify age-specific differences in stroke presentation and underlying causes.
Main Methods:
- A hospital-based observational study of 222 participants (pediatric and adult).
- Comprehensive evaluations included clinical/neurological exams, laboratory tests, cardiac assessments, and various neuroimaging techniques (CT, MRI, MRA, MRV, Doppler).
- Etiology and subtypes were classified using TOAST, a proposed pediatric classification, and OCSP criteria; severity was assessed using NIHSS and PedNIHSS.
Main Results:
- Pediatric strokes were 63.4% ischemic and 36.5% hemorrhagic; adult strokes were 84.1% ischemic and 15.8% hemorrhagic.
- For pediatric ischemic stroke, determined causes accounted for 63.6%, undetermined for 27.2%, and cardioembolic for 9.0%.
- Adult ischemic stroke subtypes included large artery disease (49.6%), small vessel disease (28.6%), and cardioembolic (6.9%).
Conclusions:
- Pediatric stroke etiology involves a greater role of non-atherosclerotic arteriopathies, coagulopathies, and hematological disorders compared to adult atherothrombotic causes.
- Multiple risk factors often coexist in pediatric ischemic stroke, highlighting the importance of thrombophilia evaluation in all childhood stroke cases.
- Prompt vascular imaging (TCD, Doppler, CT, MRI, MRA, MRV, angiography) is recommended for children diagnosed with stroke.
Background:
Even though stroke is rare in children, it is associated with serious or life-threatening consequences. Despite its rarity, the occurrence of stroke in children has age-related differences in risk factors, etiopathogenesis, and clinical presentations. Unlike adults, who have arteriosclerosis as the major cause of stroke, risk factors for pediatric strokes are multiple, including cardiac disorders, infection, prothrombotic disorders, moyamoya disease, moyamoya syndrome, and others. The goal of the current study was to compare the characteristics, clinical features, etiology, subtypes, and workup of pediatric and adult strokes.
Methods:
This was a hospital-based observational study conducted on 222 participants. All patients underwent a full clinical and neurological examination, full laboratory study, cardiac evaluation, and neuroimaging; CT scan, MRI, MRA, MRV, carotid duplex, and transcranial Doppler (TCD). Ischemic stroke (IS) etiology was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria, the "proposed classification for subtypes of arterial ischemic stroke in children," and the Oxfordshire Community Stroke Project (OCSP). Stroke severity was determined by the National Institutes of Health Stroke Scale (NIHSS) and PedNIHSS on admission.
Results:
The proportion of pediatric ischemic strokes in the current study was 63.4 percent, while hemorrhagic strokes were 36.5%. The majority of the adult patients had ischemic strokes (84.1%), while hemorrhagic strokes were noted in 15.8% of the patients. According to the original TOAST classification, in the current study, the etiology of pediatric IS was other determined causes in 63.6%, undetermined etiology in 27.2%, and cardioembolic in 9.0%. For the adult group, the major stroke subtypes were large artery disease, small vessel disease, cardioembolic, other determined causes, and undetermined etiology at 49.6%, 28.6%, 6.9%, 0.6%, and 12.5%, respectively.
Conclusions:
There is a greater etiological role for non-atherosclerotic arteriopathies, coagulopathies, and hematological disorders in pediatric stroke, while adults have more atherothrombotic causes. The co-existence of multiple risk factors in pediatric ischemic stroke is noticed. Thrombophilia evaluation is helpful in every case of childhood stroke. Children who have had a stroke should undergo vascular imaging as soon as possible. Imaging modalities include TCD and Doppler ultrasound, CT, MRI, MRA, and MRV, and cerebral angiography.
