Risk Factors and Neurologic Outcomes in Childhood Arterial Ischemic Stroke

Yıl 2017, Cilt: 7 Sayı: 3, 278 - 283, 30.09.2017

Taner Sezer

https://doi.org/10.16899/gopctd.349950

Öz

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.

Anahtar Kelimeler

Arterial Ischemic Stroke, children

Akut Arterial İskemik İnmesi Olan Çocuklarda Risk Faktörleri ve Nörolojik Bulgular

Öz

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.

Anahtar Kelimeler

Arterial iskemik inme, çocuk

Kaynakça

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