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Cerebrovascular disease in children
D Nagaraja1, A Verma, A B Taly
1Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
Insights
Pediatric stroke, though uncommon, significantly impacts children. This study highlights key clinical features, diagnostic challenges, and identified etiological factors in childhood stroke cases.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Stroke is a critical cause of morbidity in children.
- It represents 10% of strokes in young individuals and 0.7% of pediatric admissions.
Purpose of the Study:
- To analyze the clinical presentation, diagnostic findings, and etiological factors of stroke in children.
- To underscore the diagnostic challenges associated with pediatric stroke.
Main Methods:
- Retrospective analysis of 43 pediatric stroke cases over 8 years.
- Utilized clinical examination, routine laboratory tests, cranial computerized tomography (CCT), and angiograms for diagnosis.
- Investigated identified etiological factors including Moya-moya disease, arteritis, and others.
Main Results:
- Hemiplegia, convulsions, and fever were the most common clinical features.
- CCT scans revealed infarction in 95% of cases, often in the middle cerebral artery territory.
- Angiograms were abnormal in 78% of patients, complementing CCT findings.
- Identified etiological factors included Moya-moya disease, arteritis, and fibromuscular dysplasia.
Conclusions:
- Pediatric stroke presents with diverse clinical features and poses diagnostic challenges.
- Advanced imaging like CCT and angiography are crucial for diagnosis and understanding the extent of infarction.
- Identifying specific etiological factors is vital for appropriate management of childhood stroke.
Abstract:
Stroke although rare in children, is an important cause of morbidity in the paediatric age group. Over a period of 8 years, 43 children (17 boys and 26 girls) in the age groups of 1-16 years (mean 8.02 yrs) presented with stroke which constituted 10% of all strokes in the young and 0.7% of all paediatric admissions. The chief clinical features were hemiplegia (86%), convulsions (27%), fever (23%), dysphasia (23%), headache (11%) and altered level of consciousness (11%). Routine laboratory tests were non-contributory. Cranial computerized tomography (CCT) on 21 patients was abnormal in 95% and was useful in revealing the extent of infarction. Infarction was confined to middle cerebral artery territory, often involving basal ganglionic structures and was associated with focal or diffuse atrophy. Angiograms were abnormal in 78% of the patients (18/23) and were complimentary to the CCT. Etiological factors identified were: Moya-moya disease 6, arteritis 5, fibromuscular dysplasia 2, scorpion sting 2, and venous sinus thrombosis and small vessel occlusion one each. Though 23% of the patients had fever at onset, no obvious evidence of systemic or CNS infection was noticed. Stroke in children continues to pose a diagnostic challenge.