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Risk Factors and Neurologic Outcomes in Childhood Arterial Ischemic Stroke

Year 2017, Volume: 7 Issue: 3, 278 - 283, 30.09.2017
https://doi.org/10.16899/gopctd.349950

Abstract

Objective: The aim of this study is to describe clinical characteristics, treatment modalities and outcomes of children with arterial ischemic stroke (AIS). 

Material and Methods: We retrospectively reviewed the charts of 102  children (62 girls and 40 boys) with AIS admitted at our hospital between 2009 and 2015. Age at stroke, sex, medical history, family history, clinical findings upon admission, history of seizure, and radiological findings were recorded. Cardiac assessment, hematological and immunological tests, metabolic screening were all performed in the patients. 

Results: In 25 children stroke occured as a complication of cardiac disease, 12 had transient cerebral arteriopathy, 11 had Down’s syndrome, 9 had thalassemia, 7 had moyamoya disease, 6 had MTHFR mutation, 4 had homozygote for factor V Leiden, 3 had protein C deficiency, 1 had sickle cell disease, and in 24 children no underlying cause could be found. Multiple risk factors were found in 16 children and recurrent stroke was observed in 4 patients. Hemiplegia was the commonest initial clinical presentation (88.2%) followed by seizure (66.6%) and decreased level of consciousness (54.9%). The avarage length of follow-up was 32.1±5.4 months. The outcome in all 102 stroke patients was as follows: asymptomatic 57.8%; persistent neurologic deficit or epilepsy 40.2%; and death 2%. 

Conclusion: Our study showed an underlying cause for AIS in 76.5% of the patients; 42.2% of the patients either died or had motor and/or cognitive sequelae and recurrence occured despite prophylactic aspirin treatment in 4 patients.


References

  • 1. Roach ES, Golomb MR, Adams R, Biller J, Daniels S, Deveber G, Ferriero D, Jones BV, Kirkham FJ, Scott RM, Smith ER.. A scientific statement from a special writing group of the American Heart Association Stroke Council and the Council of Cardiovascular Disease in the Young. Stroke. 2008;39: 2644-91.
  • 2. de Veber G, Roach ES, Riela AR, Wiznitzer M. Stroke in children: recognition, treatment, and future directions. Semin Pediatr Neurol 2000;7:309-17.
  • 3. Simma B, Martin G, Müller T, Huemer M. Risk factors for pediatric stroke: consequences for therapy and quality of life. Pediatr Neurol. 2007;37:121-6.
  • 4. Touré A, Chabrier S, Plagne MD, Presles E, des Portes V, Rousselle C. Neurological outcome and risk of recurrence depending on the anterior vs.posterior arterial distribution in children with stroke. Neuropediatrics. 2009;40:126-8.
  • 5. Westmacott R, Askalan R, MacGregor D, Anderson P, Deveber G. Cognitive outcome following unilateral arterial ischaemic stroke in childhood:effects of age at stroke and lesion location. Dev Med Child Neurol. 2010;52:386-93.
  • 6. Incecik F, Ozlem Hergüner M, Altunbasak S. Risk factors and treatment outcomes for children with arterial ischemic stroke. J Clin Neurosci. 2010;17:1000-2.
  • 7. Lopez-Vicente M, Ortega-Gutierrez S, Amlie-Lefond C, Torbey MT. Diagnosis and management of pediatric arterial ischemic stroke. J Stroke Cerebrovasc Dis. 2010;19:175-83.
  • 8. M. Steinlin, I. Pfister, J. Pavlovic, Everts R, Boltshauser E, Capone Mori A, Gubser Mercati D, Hänggeli CA, Keller E. The first three years of the Swiss Neuropaediatric Stroke Registry (SNPSR): a population-based study of incidence, symptoms and risk factors. Neuropediatrics. 2005;36: 90–97.
  • 9. Tham EH, Tay SK, Low PS. Factors predictive of outcome in childhood stroke in an Asian population. Ann Acad Med Singapore. 2009;38:876-81.
  • 10. Kleindorfer D, Khoury J, Kissela B, Alwell K, Woo D, Miller R, Schneider A, Moomaw C, Broderick JP. Temporal trends in the incidence and case fatality of stroke in children and adolescents. J Child Neurol. 2006;21:415-8.
  • 11. Zahuranec DB, Brown DL, Lisabeth LD, Morgenstern LB. Is it time for a large, collaborative study of pediatric stroke? Stroke. 2005;36:1825-9.
  • 12. Neil Friedman. Pediatric cardiovascular disease and stroke. J Pediatr Neurol. 2010;8: 259-265 259.
  • 13. Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent childhood arterial ischemic stroke in a population-based cohort: the importance of cerebrovascular imaging. Pediatrics. 2007; 119:495–501.
  • 14. Braun KP, Bulder MM, Chabrier S, Kirkham FJ, Uiterwaal CS, Tardieu M, Sébire G. The course and outcome of unilateral intracranial arteriopathy in 79 children with ischaemic stroke. Brain 2009; 132:544-557.
  • 15. Miravet E, Danchaivijitr N, Basu H, Saunders DE, Ganesan V. Clinical and radiological features of childhood cerebral infarction following varicella zoster virus infection. Dev Med Child Neurol 2007;49:417-422.
  • 16. Amlie-Lefond C, Bernard TJ, Sébire G, Friedman NR, Heyer GL, Lerner NB, DeVeber G, Fullerton HJ. Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study. Circulation. 2009;119:1417-23.
  • 17. Goldenberg NA, Bernard TJ, Fullerton HJ, Gordon A, deVeber G. Antithrombotic treatments, outcomes, and prognostic factors in acute childhoodonset arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol 2009;8:1120-1127.
  • 18. Monagle P, Chalmers E, Chan A, Veber G, Kirkham F, Massicotte P, Michelson AD. Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2008;133:887-968.
  • 19. Christerson S, Strömberg B. Stroke in Swedish children II: long-term outcome.Acta Paediatr. 2010;99:1650-6.

Akut Arterial İskemik İnmesi Olan Çocuklarda Risk Faktörleri ve Nörolojik Bulgular

Year 2017, Volume: 7 Issue: 3, 278 - 283, 30.09.2017
https://doi.org/10.16899/gopctd.349950

Abstract

Amaç: Çalışmamızın amacı arterial iskemik inmesi (Aİİ) olan çocuklarda klinik özellikler, tedavi seçenekleri ve prognozun saptanmasıdır. 
Materyal ve Metod: Çalışmamızda Aİİ tanısıyla merkezimizde 2009 ile 2015 yılları arasında takip edilen 102 çocuğun ( 62 kız ve 40 erkek) klinik bulguları retrospektif olarak değerlendirildi.  Hastaların inme sırasındaki yaş ve cinsiyetleri, tıbbi geçmişleri, aile hikayesi, başvuru anındaki klinik buguları, epileptik nöbet hikayesi varlığı  ve radyolojik bulguları kaydedildi. Merkezimizde Aİİ tanısı alan tüm çocuklara kardiyak inceleme, hematolojik ve immunolojik tesler, doğumsal metabolik hastalıklar için taramalar yapılmaktadır. 
Sonuçlar: Aİİ'li hastalarda saptanan hastalıklar sırasıyla; kardiyak hastalık (25 hasta), geçici serebral iskemi (12 hasta), Down sendromu (11 hasta), Talasemi (9 hasta), Moyomoya hastalığı (7 hasta), homozigot MTHFR mutasyonu (6 hasta), homozigot faktör V Leiden mutasyonu (4 hasta), protein C eksikliği (3 hasta), orak hücreli anemi (1 hasta) ve 24 hastada altta yatan neden saptanamadı. Birden fazla risk faktörü 16 çocukta ve tekrarlayan inmeler 4 hastada saptandı. Hemipleji en sık saptanan klinik presentasyon (%88,2) iken, bunu nöbetler (%66,6) ve şuur değişikliği (%54,9) takip ediyordu. Ortalama klinik takip süresi 32,±5,4 idi. Aİİ'li 102 hastanın klinik takip sunuçları şu şekilde idi; asemtomatik 57,8%, kalıcı nörolojik defisit ya da epilepsi 40,2%, ölüm 2%. 
Sonuçlar: Çalışmamızda Aİİ'li çocukların %76,5'sında altta yatan bir neden saptandı, hastaların %42.2'si öldü ya da motor ve/veya mental geriliği oldu ve aspirin profilaksisine rağmen 4 hastada tekrarlayan Aİİ atağı oldu.

References

  • 1. Roach ES, Golomb MR, Adams R, Biller J, Daniels S, Deveber G, Ferriero D, Jones BV, Kirkham FJ, Scott RM, Smith ER.. A scientific statement from a special writing group of the American Heart Association Stroke Council and the Council of Cardiovascular Disease in the Young. Stroke. 2008;39: 2644-91.
  • 2. de Veber G, Roach ES, Riela AR, Wiznitzer M. Stroke in children: recognition, treatment, and future directions. Semin Pediatr Neurol 2000;7:309-17.
  • 3. Simma B, Martin G, Müller T, Huemer M. Risk factors for pediatric stroke: consequences for therapy and quality of life. Pediatr Neurol. 2007;37:121-6.
  • 4. Touré A, Chabrier S, Plagne MD, Presles E, des Portes V, Rousselle C. Neurological outcome and risk of recurrence depending on the anterior vs.posterior arterial distribution in children with stroke. Neuropediatrics. 2009;40:126-8.
  • 5. Westmacott R, Askalan R, MacGregor D, Anderson P, Deveber G. Cognitive outcome following unilateral arterial ischaemic stroke in childhood:effects of age at stroke and lesion location. Dev Med Child Neurol. 2010;52:386-93.
  • 6. Incecik F, Ozlem Hergüner M, Altunbasak S. Risk factors and treatment outcomes for children with arterial ischemic stroke. J Clin Neurosci. 2010;17:1000-2.
  • 7. Lopez-Vicente M, Ortega-Gutierrez S, Amlie-Lefond C, Torbey MT. Diagnosis and management of pediatric arterial ischemic stroke. J Stroke Cerebrovasc Dis. 2010;19:175-83.
  • 8. M. Steinlin, I. Pfister, J. Pavlovic, Everts R, Boltshauser E, Capone Mori A, Gubser Mercati D, Hänggeli CA, Keller E. The first three years of the Swiss Neuropaediatric Stroke Registry (SNPSR): a population-based study of incidence, symptoms and risk factors. Neuropediatrics. 2005;36: 90–97.
  • 9. Tham EH, Tay SK, Low PS. Factors predictive of outcome in childhood stroke in an Asian population. Ann Acad Med Singapore. 2009;38:876-81.
  • 10. Kleindorfer D, Khoury J, Kissela B, Alwell K, Woo D, Miller R, Schneider A, Moomaw C, Broderick JP. Temporal trends in the incidence and case fatality of stroke in children and adolescents. J Child Neurol. 2006;21:415-8.
  • 11. Zahuranec DB, Brown DL, Lisabeth LD, Morgenstern LB. Is it time for a large, collaborative study of pediatric stroke? Stroke. 2005;36:1825-9.
  • 12. Neil Friedman. Pediatric cardiovascular disease and stroke. J Pediatr Neurol. 2010;8: 259-265 259.
  • 13. Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent childhood arterial ischemic stroke in a population-based cohort: the importance of cerebrovascular imaging. Pediatrics. 2007; 119:495–501.
  • 14. Braun KP, Bulder MM, Chabrier S, Kirkham FJ, Uiterwaal CS, Tardieu M, Sébire G. The course and outcome of unilateral intracranial arteriopathy in 79 children with ischaemic stroke. Brain 2009; 132:544-557.
  • 15. Miravet E, Danchaivijitr N, Basu H, Saunders DE, Ganesan V. Clinical and radiological features of childhood cerebral infarction following varicella zoster virus infection. Dev Med Child Neurol 2007;49:417-422.
  • 16. Amlie-Lefond C, Bernard TJ, Sébire G, Friedman NR, Heyer GL, Lerner NB, DeVeber G, Fullerton HJ. Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study. Circulation. 2009;119:1417-23.
  • 17. Goldenberg NA, Bernard TJ, Fullerton HJ, Gordon A, deVeber G. Antithrombotic treatments, outcomes, and prognostic factors in acute childhoodonset arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol 2009;8:1120-1127.
  • 18. Monagle P, Chalmers E, Chan A, Veber G, Kirkham F, Massicotte P, Michelson AD. Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2008;133:887-968.
  • 19. Christerson S, Strömberg B. Stroke in Swedish children II: long-term outcome.Acta Paediatr. 2010;99:1650-6.
There are 19 citations in total.

Details

Subjects Health Care Administration
Journal Section Original Research
Authors

Taner Sezer

Publication Date September 30, 2017
Acceptance Date May 19, 2017
Published in Issue Year 2017 Volume: 7 Issue: 3

Cite

APA Sezer, T. (2017). Akut Arterial İskemik İnmesi Olan Çocuklarda Risk Faktörleri ve Nörolojik Bulgular. Çağdaş Tıp Dergisi, 7(3), 278-283. https://doi.org/10.16899/gopctd.349950
AMA Sezer T. Akut Arterial İskemik İnmesi Olan Çocuklarda Risk Faktörleri ve Nörolojik Bulgular. J Contemp Med. November 2017;7(3):278-283. doi:10.16899/gopctd.349950
Chicago Sezer, Taner. “Akut Arterial İskemik İnmesi Olan Çocuklarda Risk Faktörleri Ve Nörolojik Bulgular”. Çağdaş Tıp Dergisi 7, no. 3 (November 2017): 278-83. https://doi.org/10.16899/gopctd.349950.
EndNote Sezer T (November 1, 2017) Akut Arterial İskemik İnmesi Olan Çocuklarda Risk Faktörleri ve Nörolojik Bulgular. Çağdaş Tıp Dergisi 7 3 278–283.
IEEE T. Sezer, “Akut Arterial İskemik İnmesi Olan Çocuklarda Risk Faktörleri ve Nörolojik Bulgular”, J Contemp Med, vol. 7, no. 3, pp. 278–283, 2017, doi: 10.16899/gopctd.349950.
ISNAD Sezer, Taner. “Akut Arterial İskemik İnmesi Olan Çocuklarda Risk Faktörleri Ve Nörolojik Bulgular”. Çağdaş Tıp Dergisi 7/3 (November 2017), 278-283. https://doi.org/10.16899/gopctd.349950.
JAMA Sezer T. Akut Arterial İskemik İnmesi Olan Çocuklarda Risk Faktörleri ve Nörolojik Bulgular. J Contemp Med. 2017;7:278–283.
MLA Sezer, Taner. “Akut Arterial İskemik İnmesi Olan Çocuklarda Risk Faktörleri Ve Nörolojik Bulgular”. Çağdaş Tıp Dergisi, vol. 7, no. 3, 2017, pp. 278-83, doi:10.16899/gopctd.349950.
Vancouver Sezer T. Akut Arterial İskemik İnmesi Olan Çocuklarda Risk Faktörleri ve Nörolojik Bulgular. J Contemp Med. 2017;7(3):278-83.