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Published on: October 23, 2020
Impact of edema formation on functional outcome in pediatric stroke patients
Peter B Sporns1,2, Thilo Rusche1, Sarah Lee3
1Department of Neuroradiology, University Hospital Basel, Basel, Switzerland.
Insights
Children with large vessel occlusion strokes had better functional outcomes than adults, despite similar early stroke imaging characteristics. Edema formation and progression rates were comparable, suggesting age is not a barrier to stroke treatment.
Area of Science:
- Neurology
- Radiology
- Pediatrics
Background:
- Quantitative lesion net water uptake (NWU) measures vasogenic edema, an early indicator of infarct progression.
- Vasogenic edema is a key factor in stroke severity and outcomes.
Purpose of the Study:
- To compare edema formation and clinical outcomes in children versus adults after large vessel occlusion stroke.
- To investigate if higher edema in children impacts functional recovery.
Main Methods:
- Analysis of children from the Save ChildS Study with available computed tomography (CT) scans.
- Comparison of baseline and follow-up CT data with adult stroke patient data.
- Assessment of quantitative lesion net water uptake (NWU) and modified Rankin Scale (mRS) scores.
Main Results:
- No significant difference in baseline NWU between children (7.5%) and adults (7.8%).
- Children exhibited higher early edema progression rates (3.0%/h) and median ΔNWU (15.1%) compared to adults (2.3%/h and 10.5%).
- Children showed significantly better excellent (mRS 0-1: 77% vs. 14%) and favorable (mRS 0-2: 92% vs. 20%) clinical outcomes.
Conclusions:
- Children with large vessel occlusion strokes achieve better clinical outcomes than adults, irrespective of similar edema formation.
- Similar edema progression rates do not preclude favorable outcomes in pediatric stroke patients.
- Early ischemic changes and edema progression may not be valid reasons for excluding children from endovascular thrombectomy.
Background:
Quantitative lesion net water uptake (NWU) has been described as an imaging biomarker reflecting vasogenic edema as an early indicator of infarct progression. We hypothesized that edema formation measured by NWU is higher in children compared to adults but despite this functional outcome may be better in children.
Methods:
This study analyzed children enrolled in the Save ChildS Study who had baseline and follow-up computed tomography available and the data were compared to adult patients.
Results:
Some 207 patients, of whom 13 were children and 194 were adults, were analyzed. Median NWU at baseline was 7.8% (IQR: 4.3-11.3), and there were no significant differences between children and adults (7.5% vs. 7.8%; p = 0.87). The early edema progression rate was 3.0%/h in children and 2.3%/h in adults. Median ΔNWU was 15.1% in children and 10.5% in adults. Children had significantly more often excellent (mRS 0-1; children 10/13 = 77% vs. adults 28/196 = 14%; p < 0.0001) and favorable clinical outcomes (mRS 0-2, 12/13 = 92% vs. 39/196 = 20%; p < 0.0001).
Conclusions:
In this study, clinical outcomes in children with large vessel occlusion strokes were better than in adults despite similar clinical and imaging characteristics and similar edema formation. This may be impacted by the generally better outcomes of children after strokes but may demonstrate that the degree of early ischemic changes using Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and edema progression rate may not be a reason for exclusion from endovascular thrombectomy.
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