Demographic and Clinical Features of Patients With Pediatric Stroke: A Cross-Sectional Study

Year 2022, Volume: 16 Issue: 2, 93 - 99, 16.03.2022

Başak Mansız-kaplan , Arzu Yılmaz , Meliha Sevim , Barış Nacır

https://doi.org/10.12956/tchd.858272

Abstract

Objective: In the pediatric age group, it is important to detect the risk factors of stroke and diagnose it early, and prevent the recurrence of the disease. This study aimed to conduct a descriptive analysis of demographic and clinical characteristics of pediatric stroke cases in the 0-18 age group and to evaluate the relationship between etiologic causes, risk factors and functional status of these cases.

Material and Methods: The medical files of the patients followed up by the Department of Pediatric Neurology of Ankara Training and Research Hospital were retrospectively examined. Cerebral magnetic resonance imaging and laboratory data were recorded. The Gross Motor Function Classification System, Box and Block Test, Nine-Hole Peg Test were used to evaluate the patients’ current functional status.

Results: In 34 pediatric hemiplegic stroke cases, the median age of the onset of symptoms was one year (minimum 0, maximum 15 years). At the time of evaluation, hemiparesis was found in 73.5% of the cases and 41.2% had active seizures. Heterozygous factor V Leiden mutation was present in 17.6% of the patients, and homozygous MTHFR (c677c) mutation in 5.9%. When the etiologic factors were evaluated, there was a mass effect due to venous bleeding in 50%, arterial bleeding in 44.1%, and intracranial bleeding in 5.9% of the cases. Prophylaxis had been performed in 47.1% of the patients. There were no significant differences in functional parameters according to thrombophilic risk factors, whether the etiology was of arterial or venous origin, or whether they underwent prophylaxis (p>.05).

Conclusion: Half of the patients had a stroke of venous origin, and hemiparesis was present in approximately two-third of the cases. Functioning levels seemed to be independent of the presence of etiologic source or thrombophilic risk factors of the disease.

Keywords

cerebral palsy, hemiplegia, pediatric age group, stroke

Pediatrik İnmeli Hastaların Demografik ve Klinik Özellikleri: Kesitsel Bir Çalışma

Abstract

Amaç: Çocukluk yaş grubunda inme risk faktörlerinin tespit edilerek erken teşhis edilmesi ve hastalığın tekrarının önlenmesi önemlidir. Bu çalışmada, 0-18 yaş grubundaki pediatrik inme olgularının demografik ve klinik özelliklerinin tanımlayıcı bir analizinin yapılması ve bu olguların etiyolojik nedenleri, risk faktörleri ve fonksiyonel durumları arasındaki ilişkinin değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntemler: Ankara Eğitim ve Araştırma Hastanesi Çocuk Nörolojisi Bölümü tarafından takip edilen hastaların tıbbi dosyaları geriye dönük olarak incelendi. Serebral manyetik rezonans görüntüleme ve laboratuvar verileri kaydedildi. Hastaların mevcut fonksiyonel durumunu değerlendirmek için Kaba Motor Fonksiyon Sınıflandırma Sistemi, Kutu ve Blok Testi, Dokuz Delikli Peg Testi kullanıldı.

Bulgular: 34 pediatrik hemiplejik inme vakasında semptomların başlama yaşı ortanca bir yıldı (minimum 0, maksimum 15 yıl). Değerlendirme anında olguların % 73.5’ inde hemiparezi bulundu ve % 41.2’ sinde aktif nöbet öyküsü vardı. Hastaların % 17.6’ sında heterozigot faktör V Leiden mutasyonu, % 5.9’ unda homozigot MTHFR (c677c) mutasyonu mevcuttu. Etiyolojik faktörler değerlendirildiğinde olguların % 50’ sinde venöz kanamaya, % 44.1’ inde arteryel kanamaya ve % 5.9’ unda intrakraniyal kanamaya bağlı kitle etkisi vardı. Hastaların % 47.1’ ine profilaksi uygulanmıştı. Trombofilik risk faktörlerine göre, etiyolojinin arteriyel ya da venöz orijinli olmasına göre veya profilaksi uygulanıp uygulanmadığına göre fonksiyonel parametrelerde anlamlı farklılık yoktu (p> .05).

Sonuç: Hastaların yarısında venöz kaynaklı inme vardı ve vakaların yaklaşık üçte ikisinde hemiparezi mevcuttu. İşlevsel düzeyler, hastalığın etiyolojik kaynağı veya trombofilik risk faktörlerinin varlığından bağımsız görünüyordu.

Keywords

serebral palsi, hemipleji, pediatrik yaş grubu, inme

References

• 1. Rafay MF, Pontigon AM, Chiang J, Adams M, Jarvis DA, Silver F et al. Delay to diagnosis in acute pediatric arterial ischemic stroke. Stroke; a journal of cerebral circulation. 2009;40(1):58-64.
• 2. Gabis LV, Yangala R, Lenn NJ. Time Lag to Diagnosis of Stroke in Children. Pediatrics. 2002;110(5):924-8.
• 3. Bax M, Goldstein M, Rosenbaum P, Leviyon A, Paneth N, Dan B et al. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol 2005;47(8):571-6.
• 4. Lynch JK, Hirtz DG, DeVeber G, Nelson KB. Report of the National Institute of Neurological Disorders and Stroke Workshop on Perinatal and Childhood Stroke. Pediatrics. 2002;109(1):116-23.
• 5. Kirton A, deVeber G. Advances in perinatal ischemic stroke. Pediatric neurology. 2009;40(3):205-14.
• 6. Felling RJ, Sun LR, Maxwell EC, Goldenberg N, Bernard T. Pediatric arterial ischemic stroke: Emidemiology, risk factors, and management. 2017;67:23-33.
• 7. Fullerton HJ, Wu YW, Zhao S, Johnston SC. Risk of stroke in children: ethnic and gender disparities. Neurology. 2003;61(2):189-194.
• 8. Singh R, Cope WP, Zhou Z, De Witt ME, Boockvar JA, Tsiouris AJ. Isolated cortical vein thrombosis: case series. J Neurosurg. 2015;123(2):427-433.
• 9. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997;39:214-23. 3.
• 10. Palisano RJ, Hanna SE, Rosenbaum PL, Russell DJ, Walter SD, Wood EP et al. Validation of a model of gross motor function for children with cerebral palsy. Phys Ther 2000;80:974-85.
• 11. Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol. 2008 Oct;50(10):744-50.
• 12. Eliasson AC, Krumlinde-Sundholm L, Rösblad B, Beckung E, Arner M, Ohrvall AM et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006 Jul;48(7):549-54.).
• 13. Akpinar P, Tezel CG, Eliasson AC, Icagasioglu A. Reliability and cross-cultural validation of the Turkish version of Manual Ability Classification System (MACS) for children with cerebral palsy. Disabil Rehabil. 2010;32(23):1910-6.
• 14. Connell LA, Tyson SF. Clinical reality of measuring upper-limp ability in neurologic conditions. A systematic review. Arch Phys Med Rehabil 2012;93(2): 221-8.
• 15. Jongbloed-Pereboom M, Nijhuis-van der Sanden MW, Steenbergen B. Norm scores of the box and block test for children ages 3-10 years. Am J Occup Ther. 2013 May-Jun;67(3):312-8.
• 16. Poole JL, Burtner PA, Torres TA, McMullen CK, Markham A, Marcum ML et al. Measuring dexterity in children using the Nine-hole Peg Test. J Hand Ther. 2005 Jul-Sep;18(3):348-51.
• 17. Wu YW, Lindan CE, Henning LH, Yoshida CK, Fullerton HJ, Ferriero DM et al. Neuroimaging abnormalities in infants with congenital hemiparesis. Pediatr Neurol 2006;35:191–6.
• 18. Golomb MR, MacGregor DL, Domi T, Armstrong DC, McCrindle BW, Mayank S et al. Presumed pre- or perinatal arterial ischemic stroke: risk factors and outcomes. Ann Neurol 2001;50:163–8.
• 19. Kitai Y, Haginoya K, Hirai S, Ohmura K, Ogura K, Inui T et al. Outcome of hemiplegic cerebral palsy born at term depends on its etiology. Brain Dev.2016;38:267-73.
• 20. Steinlin M, Roellin K, Schroth G. Long-term follow-up after stroke in childhood. Eur J Pediatr. 2004;163(4-5):245-50. doi: 10.1007/s00431-003-1357-x.
• 21. Grunt S, Mazenauer L, Buerki SE, Boltshauser E, Mori AC, Datta AN et al. Incidence and outcomes of symptomatic neonatal arterial ischemic stroke. Pediatrics. 2015;135(5):e1220-8.
• 22. Laugesaar R, Kolk A, Tomberg T, Metsvaht T, Lintrop M, Varendi H et al. Acutely and retrospectively diagnosed perinatal stroke: a population-based study. Stroke; a journal of cerebral circulation. 2007;38(8):2234-40.