Related Experiment Videos
Stroke in children under 16 years of age. Clinical and etiological difference with adults
M Giroud1, M Lemesle, G Madinier
1Consultation de Neurologie Infantile, Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France.
Insights
Pediatric stroke, including ischemic and hemorrhagic types, was evaluated using advanced neuroimaging. Despite frequent late-onset neurological issues like hemidystonia and epilepsy, outcomes were generally favorable.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuroimaging
Background:
- Stroke in children is less common than in adults but carries significant morbidity.
- Understanding the specific clinical features, etiological mechanisms, and outcomes of pediatric stroke is crucial for effective management.
Purpose of the Study:
- To re-evaluate the clinical features of stroke in children.
- To assess the outcomes of pediatric stroke.
- To determine the role of various etiological mechanisms in pediatric stroke using CT-scan and MRI.
Main Methods:
- A 10-year retrospective review (1985-1995) of 54 pediatric stroke patients at Dijon Childhood Neurology Clinic.
- Diagnosis confirmed by CT-scan, angiography, and magnetic resonance imaging (MRI).
- Comprehensive investigations including coagulation factors, lipid status, and cardiac evaluations were performed based on stroke type.
Main Results:
- 54 pediatric stroke cases identified: 57% ischemic (31 cases) and 43% hemorrhagic (23 cases).
- Common causes included pre-existing heart disease, moyamoya disease, leukemia, infections, and trauma for ischemic stroke; arteriovenous malformations, aneurysms, and cavernomas for hemorrhagic stroke.
- Basal ganglia infarction was noted in 14 ischemic stroke cases. Clinical course showed low mortality, but frequent long-lasting seizures and hemidystonia.
Conclusions:
- Neuroimaging highlights the significant occurrence of hemorrhagic stroke and basal ganglia infarctions in children.
- Follow-up demonstrated good to complete resolution of neurological deficits.
- Late-onset hemidystonia and epilepsy are frequent sequelae, necessitating long-term monitoring.
Objectives:
The aim of this study was to re-evaluate the clinical features of stroke in children, their outcome and the place of the different mechanisms, in the light of CT-scan and magnetic resonance imaging.
Methods:
A 10-year review of the Dijon Childhood Neurology Clinic experience (1985-1995) identified 54 patients with arterial stroke. Diagnosis was established by CT-scan and angiography and by magnetic resonance imaging from 1987. When an hemorrhagic stroke was identified, a cerebral arteriogram and an investigation of the coagulation factors were performed. When an ischemic stroke was identified, the following tests were performed: an ultrasound examination of the cervical arteries, a cerebral arteriogram, a lumbar puncture, an investigation of the coagulation factors and lipid status, a measurement of homocystine in the plasma and the urine, an electrocardiogram, a Holter procedure and a cardiac echography.
Results:
During the 11 full calendar years of this study, we observed 54 stroke patients. There were 31 cases of ischemic stroke, representing some 57% of the total, as well as 23 cases of hemorrhagic stroke, representing 43% of the total. Of the 31 cases with ischemic stroke, 4 had no known predisposing condition, 6 occurred in children with pre-existing heart disease, 2 had moya-moya disease, 2 had leukemia, 2 had a carotid dissection, 1 had an hemolytic-uremic syndrome, and 14 were observed in patients with other associated conditions, such as infections (7 cases) or slight cranial trauma (7 cases). On CT-scan, a basal ganglia infarction was identified in 14 cases. Among the 23 hemorrhagic strokes, 9 were due to arteriovenous malformations, 2 to arterial aneurysm and 5 to cavernomas. Two cases occurred in hemophilia, 2 in idiopathic thrombocytopenic purpura, and 2 after throat infections. One case had no etiologic factor. Clinical course was marked by a low mortality rate even in hemorrhagic stroke, long-lasting seizures, and hemidystonia.
Conclusion:
This neuro-imaging survey focused on the real place of hemorrhage and basal ganglia infarctions in children under 16 years of age, compared to adulthood. Follow-up demonstrated good or complete resolution of neurological deficits despite the frequent late hemidystonia and late epilepsy.