Acute Ischemic Stroke in Children versus Young Adults: Bigi S, Fischer U, Wehrli E, et al. Ann Neurol 2011;70:245–54.

Abstract

This study from Switzerland compared 128 children (ages 1 month to 16 years) to 199 young adults (ages 16-45 years) who suffered an acute ischemic stroke from January 2000 to December 2008. Data for children were collected from the Swiss Neuro Pediatric Stroke Registry (a Swiss national registry) and data for young adults were collected from the Bernese stroke registry (a hospital-based registry). Children were more likely to be male (62% vs. 49%, p = 0.023) and had fewer risk factors such as hypertension (p = 0.001), hypercholesterolemia (p = 0.003), or a family history of stroke (p = 0.048). Stroke etiology in children was more likely to be “other determined cause” (51% vs. 29%, p < 0.001), steno-occlusive arteriopathy (18% vs. 0%, p < 0.001), and moyamoya syndrome (5% vs. 0.2%, p = 0.007). Stroke etiology in young adults was more likely to be cervicocerebral artery dissections (23% vs. 13%, p = 0.005) or cardioembolic (37% vs. 17%, p < 0.001). Initial stroke severity graded using the pediatric version of the National Institutes of Health Stroke Scale (PedNIHSS) for children and NIHSS for young adults was similar in both groups. There was also no difference in outcome at 3 and 6 months as determined by a modified Rankin scale score. Mortality rates were similar as well (4% in children and 6% in young adults, p = 0.436). Whereas 6 of 8 young adults died due to their stroke, 3 of 8 children died due to the underlying disease that provoked the stroke. A low PedNIHSS or NIHSS score was the most important predictor of favorable outcome in both groups (p < 0.001).