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[Cerebrovascular accidents in childhood]
M J Reguilón1, P Gorrotxategi, R Gaztañaga
1Servicio de Pediatria y Neurologia Infantil, Hospital Materno-Infantil Ntra, Sra. de Aránzazu, Donostia, San Sebastian.
Insights
Pediatric stroke, encompassing both ischemic and hemorrhagic types, affects children under 15. Ischemic stroke recovery impacts daily life more than hemorrhagic stroke recovery.
Area of Science:
- Neurology
- Pediatrics
Context:
- Retrospective analysis of acute stroke in children under 15 years over a decade.
- Incidence rate of 1.26 per 100,000 inhabitants under 15.
- Study included 20 pediatric stroke cases (12 girls, 8 boys).
Purpose:
- To analyze the etiology, presentation, and outcomes of acute stroke in pediatric patients.
- To compare the characteristics and recovery of ischemic versus hemorrhagic stroke in children.
- To identify factors influencing long-term prognosis in pediatric stroke.
Summary:
- Ten cases of ischemic stroke (etiologies: fibromuscular dysplasia, arthritis, meningitis, Moya-Moya) and ten of hemorrhagic stroke (etiology: arteriovenous malformation).
- Ischemic stroke predominantly presented as hemiplegia; hemorrhagic stroke as intracranial hypertension.
- Outcomes indicated worse long-term functional recovery for ischemic stroke compared to hemorrhagic stroke, with 3 deaths in the hemorrhagic group.
Impact:
- Highlights the distinct etiologies and presentations of pediatric ischemic and hemorrhagic strokes.
- Suggests poorer long-term functional outcomes for pediatric ischemic stroke, impacting daily life.
- Informs clinical management and prognosis for childhood stroke.
Abstract:
A retrospective study of acute stroke diagnosed in the last ten years (20 cases: 12 girls and 8 boys) with an incidence rate of 1.26 cases per year per 100,000 inhabitants under 15 years of age) in our health area. Average age; 7.83 years (range: 2 months to 15 years). Confirming diagnosis was performed by computerised tomography (CT) scan, magnetic resonance (MR) imaging, echography and/or cerebral arteriography. Ten cases of ischaemic stroke and ten of haemorrhagic stroke were catalogued. Average follow-up was 5.45 years (range: 9 months to 10.8 years). Fibromuscular dysplasia, arthritis and meningitis are predominant in ischaemic stroke etiology, there also being one case of Moya-Moya. Haemorrhagic strokes are mostly produced by arteriovenous malformation. The predominant presenting form of ischaemic stroke was hemiplegia and of haemorrhagic strokes it was intracranial hypertension. There were no deaths as a result of ischaemic accidents but three in the cerebral haemorrhage group. Treatment was surgical in two cases, embolisation in two others and medical support in the remaining sixteen. There were no cases of relapse, except in the Moya-Moya case. Clinical position and the ability to carry on day to day life were most affected in the cerebral attack cases, which would indicate ischaemic stroke recuperation is worse than that for haemorrhagic strokes.