Assessment of Post-Stroke Consequences in Pediatric Ischemic Stroke in the Context of Neuroimaging Results-Experience from a Single Medical Center.

Ilona Kopyta,Dorota Raczkiewicz,Beata Sarecka-Hujar,Magdalena Machnikowska-Sokołowska,Katarzyna Gruszczyńska

doi:10.3390/children8040292

Abstract

Arterial ischemic stroke (AIS) in children is a rare condition; its frequency is estimated at 0.58 to 7.9 new onsets in 100,000 children per year. The knowledge on risk factors, clinical outcomes and consequences of pediatric AIS is increasing. However, there are still many unknowns in the field. The aim of the study was to analyze the clinical presentation of pediatric AIS and its consequences according to the neuroimaging results and location of ischemia. The research was retrospective and observational. The analyzed group consisted of 75 AIS children (32 girls, 43 boys), whereby the age of the patients ranged from 9 months to 18 years at stroke onset. All the patients were diagnosed and treated in one tertiary center. The most frequent stroke subtype was total anterior circulation infarct (TACI) with most common ischemic focus location in temporal lobe and vascular pathology in middle cerebral artery (MCA). The location of ischemic focus in the brain correlated with post-stroke outcomes: intellectual delay and epilepsy, hemiparesis corresponded to the location of vascular pathology. A correlation found between ischemic lesion location and vascular pathology with post-stroke consequences in pediatric AIS may be important information and helpful in choosing proper early therapy. The expected results should lead to lesser severity of late post-stroke outcomes.

Highlights

Arterial ischemic stroke (AIS) is characterized by sudden onset of focal or generalized brain function disturbances caused by cerebral vascular dysfunction and correlated with the location of vascular pathology; the symptoms have to last for over 24 h [1].The up-to-date literature provides many studies on epidemiology, clinical presentation, risk factors, treatment and prevention of AIS in adults
We found the records of AIS patients’ by ICD-10 (I63, I64, I68, G46) in the hospital record systems
The most common stroke subtype was total anterior circulation infarct (TACI), which was present in 32% of children

Summary

Introduction

The up-to-date literature provides many studies on epidemiology, clinical presentation, risk factors, treatment and prevention of AIS in adults. In the last few years the research on AIS in pediatric populations has become more frequent—in literature reviews many former manuscripts were based on small patient cohorts. The presentation of ischemic lesions in the results of neuroimaging studies is, in some cases, inconsistent with the clinical presentation. This happens, for example, in patients with sickle cell disease (SCD) in whom new stroke lesions visible in an magnetic resonance (MR) of the brain do not show clinical symptoms and such a condition is called a silent stroke [2]. The additional problem is the age of children enrolled in research on AIS

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