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Stroke in children and sickle-cell disease: Baltimore-Washington Cooperative Young Stroke Study
C J Earley1, S J Kittner, B R Feeser
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Sickle-cell disease is a major cause of childhood stroke in biracial populations. This study highlights its significant role in pediatric ischemic stroke cases.
Area of Science:
- Pediatric Neurology
- Epidemiology
- Vascular Biology
Background:
- Childhood stroke is a significant health concern.
- Understanding the causes of stroke in children is crucial for effective prevention and treatment.
- The Baltimore-Washington Cooperative Young Stroke Study is the largest biracial population-based investigation into the etiology of pediatric stroke.
Purpose of the Study:
- To examine the causes of ischemic stroke and intracerebral hemorrhage in children.
- To determine the incidence rates of childhood stroke in a biracial urban-suburban population.
- To identify risk factors contributing to stroke in pediatric patients.
Main Methods:
- Retrospective review of medical records for children aged 1-14 years diagnosed with ischemic stroke or intracerebral hemorrhage.
- Inclusion of data from all hospitals in central Maryland and Washington, DC for the years 1988 and 1991.
- Independent review of medical records by two neurologists to confirm stroke diagnosis and extract relevant clinical information.
Main Results:
- Eighteen cases of ischemic infarction and 17 of intracerebral hemorrhage were identified.
- Sickle-cell disease was the most frequent cause of ischemic stroke (39%), followed by vasculopathy (33%).
- Arteriovenous malformation (29%) and hematologic disorders (23%) were leading causes of intracerebral hemorrhage. Overall childhood stroke incidence was 1.29 per 100,000 per year.
Conclusions:
- Sickle-cell disease significantly contributes to childhood stroke, particularly ischemic stroke.
- The study underscores the importance of considering sickle-cell disease in the differential diagnosis of stroke in children, especially in biracial populations.
- Findings emphasize the need for targeted screening and management strategies for pediatric stroke patients with sickle-cell disease.
Background/Purpose:
The Baltimore-Washington Cooperative Young Stroke Study is the largest biracial urban-suburban population-based study to examine the etiology of strokes in children.
Methods:
We identified all children aged 1 to 14 years discharged from all 46 hospitals in central Maryland and Washington, DC with a diagnosis of ischemic stroke and intracerebral hemorrhage in the years 1988 and 1991. Each medical record was reviewed by two neurologists for appropriateness of the diagnosis of stroke and for information on the patient's history, clinical presentation, pertinent investigations, hospital stay, and outcome at time of discharge.
Results:
Eighteen children with ischemic infarction and 17 with intracerebral hemorrhage were identified. The most common cause of ischemic stroke was sickle-cell disease (39%), followed by vasculopathic (33%) and indeterminate (28%) causes. Causes of intracerebral hemorrhages were arteriovenous malformation (29%), hematologic (23%), vasculopathy (18%), surgical complication (12%), coagulopathy (6%), and indeterminate (12%). The overall incidence for childhood stroke was 1.29 per 100,000 per year, with ischemic stroke occurring at a rate of 0.58 per 100,000 and intracerebral hemorrhage occurring at a rate of 0.71 per 100,000. The incidence of stroke among children with sickle-cell disease was estimated to be 0.28% or 285 per 100,000 per year.
Conclusion:
Sickle-cell disease plays a disproportionately high role in childhood stroke when a biracial population is surveyed.