Yenidoğan Ve Çocukluk Çağı İnmelerinde Klinik Ve Protrombotik Risk Faktörleri: Bir Retrospektif Araştırma

Year 2019, Volume: 7 Issue: Ek - IRUPEC 2019 Kongresi Tam Metin Bildirileri, 446 - 452, 10.12.2019

Rukiye Ünsal Saç , İkbal Ok Bozkaya Ok Bozkaya , Abdurrahman Kara

Abstract

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.

Keywords

Child, Stroke, Intracranial embolism and thrombosis

References

• 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