Cureus · 2024
Arterial Ischemic Stroke in Pediatric Patients: A Tertiary Hospital Experience.
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Camacho-Sampaio Margarida, Costa Mariana, Lima Cláudia, Santos Constança, Amaral Joana, Palavra Filipe, Pereira Cristina, Ribeiro Joana
Аннотация
INTRODUCTION: Childhood arterial ischemic stroke is a rare condition. Its true incidence is unknown as it is likely underdiagnosed. Outcomes are generally favorable but it is still a significant cause of mortality and morbidity in children. We aimed to characterize patients with childhood arterial ischemic stroke regarding risk factors, etiology, treatment, and outcome.
METHODS: This was a retrospective observational study that analyzed demographic and clinical data of patients aged 28 days to 18 years of age diagnosed with arterial ischemic stroke and admitted to the neuropediatric department at a tertiary hospital in Coimbra, Portugal, between 2015 and 2022.
RESULTS: A total of 19 patients were included, with a median age of 12.13 years; 10 (53%) were male children and 13 (63%) had a pre-existing medical condition. Eleven patients (58%) presented with sudden focal deficit and eight (42%) with only unspecific/non-localizing symptoms (headache, altered mental status, and seizure). The middle cerebral artery was the most affected (n=13, 68%) and regarding etiology, seven (37%) were cardioembolic and another seven (37%) were unilateral focal cerebral arteriopathy. Conservative measures were used for the treatment of 11 (90%) patients and two underwent mechanical thrombectomy successfully. Regarding sequelae, four patients (21%) had moderate to severe disability. The main sequelae was chronic motor deficit (n=8, 42%), followed by cortical deficit (n=4, 21%). Two patients developed vascular epilepsy.
CONCLUSIONS: While most patients presented with a sudden focal deficit, the occurrence of non-localizing symptoms was high. Conservative treatment was the most used, but there were good results in patients submitted to invasive treatment. Our results corroborate the high morbidity associated with childhood arterial ischemic stroke and the need for a high clinical suspicion to identify these cases and treat them promptly.
METHODS: This was a retrospective observational study that analyzed demographic and clinical data of patients aged 28 days to 18 years of age diagnosed with arterial ischemic stroke and admitted to the neuropediatric department at a tertiary hospital in Coimbra, Portugal, between 2015 and 2022.
RESULTS: A total of 19 patients were included, with a median age of 12.13 years; 10 (53%) were male children and 13 (63%) had a pre-existing medical condition. Eleven patients (58%) presented with sudden focal deficit and eight (42%) with only unspecific/non-localizing symptoms (headache, altered mental status, and seizure). The middle cerebral artery was the most affected (n=13, 68%) and regarding etiology, seven (37%) were cardioembolic and another seven (37%) were unilateral focal cerebral arteriopathy. Conservative measures were used for the treatment of 11 (90%) patients and two underwent mechanical thrombectomy successfully. Regarding sequelae, four patients (21%) had moderate to severe disability. The main sequelae was chronic motor deficit (n=8, 42%), followed by cortical deficit (n=4, 21%). Two patients developed vascular epilepsy.
CONCLUSIONS: While most patients presented with a sudden focal deficit, the occurrence of non-localizing symptoms was high. Conservative treatment was the most used, but there were good results in patients submitted to invasive treatment. Our results corroborate the high morbidity associated with childhood arterial ischemic stroke and the need for a high clinical suspicion to identify these cases and treat them promptly.