TY  - JOUR
T1  - Yenidoğan Ve Çocukluk Çağı İnmelerinde Klinik Ve Protrombotik Risk Faktörleri: Bir Retrospektif Araştırma
AU  - Ünsal Saç, Rukiye
AU  - Ok Bozkaya, İkbal Ok Bozkaya
AU  - Kara, Abdurrahman
PY  - 2019
DA  - December
Y2  - 2020
JF  - Pediatric Practice and Research
JO  - pediatr pract res
PB  - Resul YILMAZ
WT  - DergiPark
SN  - 2147-6470
SP  - 446
EP  - 452
VL  - 7
IS  - Ek
LA  - en
AB  - AIM: Neonatal and childhood stroke has high morbidity and mortality, associates with co-morbid conditions, it is difficult to diagnose and the treatment is uncertain. We aimed to examine epidemiology and long term outcomes of childhood stroke patients, followed our department.MATERIALS AND METHODS: A retrospective study of enrolled pediatric stroke patients at a pediatric hematology department of a Children's Hospital. The disease presentations, prothrombotic risk factors, co-morbid conditions, stroke-related death or neurological deficits of the children followed-up with stroke diagnosis were recorded.RESULTS: A total of 115 children (min-max: 0-16.8 years, median age of diagnosis: 2 years, 49.6% girls) were included. Paresis or plegia (56.5%), convulsions (43.5%), and cranial nerve palsies (10.4%) were most common presentations. Co-morbid conditions were common (69%); the most common were infections (22.6%) and congenital cardiac diseases (20.8%). In 47.7% of the patients who presented with paresis or plegia, stroke was diagnosed within 30 days after stroke; the rest was diagnosed later. Among the determined prothrombotic risk factors, elevated homocysteine levels were the most common (27%), followed by factor V G1691A mutations (20%), and elevated lipoprotein (a) (19.1%) levels. Neurological sequel rate was 62.5%. Mortality rate was 2.6%.CONCLUSIONS: Childhood stroke is associated with a variety of co-morbid conditions and hereditary and acquired prothrombotic risk factors. Stroke in children has a high sequel rate. We think that, delayed diagnosis and treatment in our study group could be the reason for this result.
KW  - Child
KW  - Stroke
KW  - Intracranial embolism and thrombosis
CR  - References 
1. 	Bernson-Leung ME, Rivkin MJ. Stroke in Neonates and Children. Pediatr Rev. 2016;37(11):463-77. PMID: 27803143; doi: 10.1542/pir.2016-0002.
2. 	Pipe SW, Goldenberg NA. Acquired disorders of hemostasis. In Nathan DG, Orkin SH, Ginsburg D, et al. Nathan and Oski’s Hematology of Infancy and Childhood. 7th ed. Philadelphia: WB Saunders; 2009. p. 1591-620.
3. 	deVeber G, Andrew M, Adams C, et al. Cerebral sinovenous thrombosis in children. N Engl J Med. 2001;345(6):417-23. PMID: 11496852; doi: 10.1056/NEJM200108093450604.
4. 	deVeber G. In pursuit of evidence-based treatments for paediatric stroke: the UK and Chest guidelines. Lancet Neurol. 2005;4(7):432-6. PMID: 15963446; doi: 10.1016/S1474-4422(05)70120-4.
5. 	Bernard TJ, Goldenberg NA. Pediatric arterial ischemic stroke. Hematol Oncol Clin North Am. 2010:24(1);167-80. PMID: 20113901; doi: 10.1016/j.hoc.2009.11.007.
6. 	Se´bire G, Tabarki B, Saunders DE, et al. Cerebral venous sinus thrombosis in children: risk factors, presentation, diagnosis and outcome. Brain. 2005;128(Pt 3):477-89. PMID: 15699061; doi: 10.1093/brain/awh412. 
7. 	Felling RJ, Sun LR, Maxwell EC, Goldenberg N, Bernard T. Pediatric arterial ischemic stroke: Epidemiology, risk factors, and management. Blood Cells Mol Dis. 2017;67:23-33. PMID: 28336156; doi: 10.1016/j.bcmd.2017.03.003.
8. 	Brugnara C. Appendices: Reference Values in Infancy and Childhood. In Nathan DG, Orkin SH, Ginsburg D, et al. Nathan and Oski’s Hematology and Oncology of Infancy and Childhood. 7th ed. Philadelphia: WB Saunders; 2009. p. 1769-96.
9. 	Altuntaş N, Soylu K, Suskan E, Akar N. Homocysteine levels in Turkish children. Turk J Haematol. 2004;21(2):79-82. PMID: 27263843
10. 	Lopez-Vicente M, Ortega-Gutierrez S, Amlie-Lefond C, Torbey MT. Diagnosis and management of pediatric arterial ischemic stroke. J Stroke Cerebrovasc Dis. 2010;19(3):175-183. PMID: 20434043; doi: 10.1016/j.jstrokecerebrovasdis.2009.03.013.
11. 	Witmer C, Ichord R. Crossing the blood-343 brain barrier: clinical interactions between neurologists and hematologists in pediatrics-advances in childhood arterial ischemic stroke and cerebral venous thrombosis. Curr Opin Pediatr. 2010;22(1):20-7. PMID: 19996969; doi: 10.1097/MOP.0b013e3283350d94.
12. 	Gabis LV, Yangala R, Lenn NJ. Time lag to diagnosis of stroke in children. Pediatrics. 2002;110(5):924-8. PMID: 12415031
13. 	Pongmoragot J, Saposnik G. Intracerebral hemorrhage from cerebral venous thrombosis. Curr Atheroscler Rep. 2012;14(4):382-9. PMID: 22664979; doi: 10.1007/s11883-012-0260-1.
14. 	deVeber G. Risk factors for childhood stroke: little folks have different strokes! Ann Neurol. 2003;53(2):149-50. PMID: 12557279; doi: 10.1002/ana.10461.
15. 	Golomb MR, Fullerton HJ, Nowak-Gottl U, Deveber G. Male predominance in childhood ischemic stroke: findings from the international pediatric stroke study. Stroke. 2009;40(1):52-7. PMID: 18787197; doi: 10.1161/STROKEAHA.108.521203.
16. 	Barnes C, Deveber G. Prothrombotic abnormalities in childhood ischaemic stroke. Thromb Res. 2006;118(1):67-74. PMID: 16039697; doi:10.1016/j.thromres.2005.05.021.
17. 	Kenet G ,Lütkhoff LK, Albisetti M, et al. Impact of thrombophilia on risk of arterial ischemic stroke or cerebral sinovenous thrombosis in neonates and children: a systematic review and meta-analysis of observational studies. Circulation. 2010;121(16):1838-47. PMID: 20385928; doi: 10.1161/CIRCULATIONAHA.109.913673
18. 	Akar N, Akar E, Deda G, Sipahi T, Orsal A. FactorV1691 G-A, prothrombin 20210 G-A, and methylenetetrahydrofolate reductase 677 C-T variants in Turkish children with cerebral infarct. J Child Neurol. 1999;14(11):749-51. PMID: 10593555; doi: 10.1177/088307389901401113
19. 	Rosenson RS, Stein JH, Durrington P, Freeman MW (Ed), Saperia GM (Ed). Lipoprotein(a) and cardiovascular disease. UptoDate. April 29, 2013. Available at: https://www.uptodate.com/contents/lipoprotein-a-and-cardiovascular-disease/print
20. 	Poort SR, Rosendaal FR, Reitsma PH, Bertina RM. A common genetic variation in the 3’- untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis. Blood. 1996;88(10):3698-703. PMID: 8916933
21. 	Cumming AM, Keeney S, Salden A, et al. The prothrombin gene G20210A variant: Prevalence in a UK anticoagulant clinic population. Br J Haematol. 1997;98(2):353-5. PMID: 9266933
UR  - https://dergipark.org.tr/en/pub/pprjournal/issue//669001
L1  - https://dergipark.org.tr/en/download/article-file/927018
ER  -