No abstract

Background: In chidden, the nonspecific presentation of posterior circulation arterial ischemic strokes (PAIS) poses challenges. Additionally, PAIS differ markedly from anterior circulation strokes. Incidence data is lacking and the information about outcome in children with PAIS is limited. Objectives: This study was aimed to calculate the incidence of and to review the clinical presentation, outcome and prognostic predictors of PAIS in children. Methods: A retrospective review of a population based cohort of children, birth to 18 years, in Manitoba, Canada, with PAIS, from January 1992 to December 2010. Data regarding demographics, clinical features and outcome of children with PAIS was collected. Results: Twenty four children with PAIS, 54.2% male, average age 5 years, were identified. Our ratio of PAIS to AIS was 20%, with an estimated incidence rate of 1 person per 10,000 if followed for 15 years. Warning symptoms before stroke onset were present in 33%. Seventy-one percent presented with sensorimotor deficits, 75% with impaired consciousness and 29% with seizures or posturing. Identifiable risk factors were present in two thirds: vasculopathy 25%, infection 21%, trauma 12.5% and congenital heart disease 12.5%. Average Pediatric National Institute of Health Stroke Severity Scale (PedNIHSS) at presentation was 11. Average Pediatric Stroke Outcome Measure (PSOM) at 3 months was 1.35. We found poor outcomes in patients with aboriginal ancestry (45.8%,p=0.003), high PedNIHSS score (p=0.02), bilateral infarction(42%,p=0.003), large artery infarcts (53%,p=0.02), occipital lobe infarcts(42%,p=0.04) and presence of vasculopathy (25%,p=0.05). Presence of abnormalities on vascular imaging trended towards recurrence (p=0.07). Outcome at 3 months correlated with outcome at 12 and 24 months (p<0.001). Conclusion: Our study is the first to report a population-based incidence of PAIS in children. The incidence rate and the predictors of outcome provide valuable information that will help direct treatment and prognostication of children with PAIS. Our data calls for close observation and management of children with suspected PAIS, in particular aboriginal patients, patients with bilateral and large infarction and abnormal vascular imaging.