A subgroup of children with arterial ischemic stroke in the pre- or perinatal period present with delayed diagnosis. We identified 22 children who met the following criteria: (1) normal neonatal neurological history, (2) hemiparesis and/or seizures first recognized after two months of age, and (3) computed tomography or magnetic resonance imaging showing remote cerebral infarct. Laboratory evaluations included protein C, protein S, antithrombin, activated protein C resistance screen (APCR), Factor V Leiden (FVL), prothrombin gene defect, methylene tetrahydrofolate reductase variant (MTHFR), anticardiolipin antibody (ACLA), and lupus anticoagulant. Not all children received all tests. Age at last visit ranged from 8 months to 16.5 years (median 4 years). Twelve were boys. Fourteen had left hemisphere infarcts. Median age at presentation was 6 months. Eighteen had gestational complications. Fourteen children had at least transient coagulation abnormalities (ACLA = 11, ACLA + APCR = 1, APCR = 2 with FVL + MTHFR = 1); six of these children had family histories suggestive of thrombosis. Cardiac echocardiogram was unremarkable in the 15 tested. Outcomes included persistent hemiparesis in 22; speech, behavior, or learning problems in 12; and persistent seizures in five, with no evidence of further stroke in any patient. The persistence and importance of coagulation abnormalities in this group need further study.

Background and Purpose-The Pediatric Stroke Outcome Measure (PSOM) is an objective, disease-specific outcome measure containing 115 test items suitable for newborn to adult ages. The PSOM measures neurological deficit and function across 5 subscales: right sensorimotor, left sensorimotor, language production, language comprehension, and cognitive/behavior yielding a final 10-point deficit score. The goal of this study was to examine PSOM construct validity in measuring neurological outcome in pediatric stroke survivors and interrater reliability (IRR) for both prospective and retrospective scoring. Methods-For construct validity, PSOM subscale scores were correlated with scores on standardized neuropsychological measures matched by functional domain. We assessed IRR by comparing same-day "live" PSOM scores from 2 independent raters in 10 children (prospective IRR) and by comparing PSOM scores estimated from medical dictations across 5 raters in another 10 children (retrospective IRR). Key Words: outcome measures Ⅲ pediatric stroke Ⅲ PSOM Ⅲ validation study S troke during childhood is an increasingly recognized cause of significant long-term morbidity that creates a substantial burden of illness per affected individual. 1 Childhood stroke incidence is 5 to 8 per 100 000 children annually with approximately 50% ischemic including arterial ischemic stroke (AIS) or cerebral sinovenous thrombosis (CSVT). 2,3 Neonatal incidence is higher at 1 in 3000 to 5000 live births. 4,5 Resultant neurological deficits are reported in 50% to 90% of children and include motor, language, and cognitive deficits. 1,6 -10 Outcomes research and clinical trials require a feasible, valid, and reliable outcome measure in pediatric stroke. Results-WeOutcome measures developed for diffuse cerebral pediatric disorders including cerebral palsy, HIV, adrenoleukodystrophy, and head trauma 1 may be insensitive to the focal and sometimes mild deficits that result from pediatric stroke. The Rankin Scale, Barthel Index, and other adult stroke scales 11 are not applicable to young children due to their reliance on self-reporting and independence in activities of daily living. Finally, across the adult years, expected performance is similar in contrast to children in whom abilities change considerably with maturation from infancy to teenage years.The Pediatric Stroke Outcome Measure (PSOM) is an objective disease-specific measure of neurological recovery after childhood stroke. The PSOM was developed and implemented from 1994 in a prospective outcome study in our institutional Children's Stroke Clinic in Toronto, Canada. 1,12 Currently, the PSOM is also in use in the International Pediatric Stroke Study 13 and multiple other pediatric stroke studies. 8,14,15 Received October 3, 2011; accepted February 10, 2012 Methods Subject SelectionBeginning in 1994, children diagnosed with acute AIS or CSVT at the Hospital for Sick Children, Toronto, Canada, were prospectively enrolled in a longitudinal pediatric stroke outcome study. Children with outcome assess...

Craniocervical arterial dissection is a recognized cause of arterial ischemic stroke in children. Whether children with craniocervical arterial dissection have dissection characteristics different from those of adults is unclear. A retrospective review of children, 1 month to 18 years of age, with dissection from two Canadian pediatric ischemic stroke registry centers was conducted. From 213 patients with arterial ischemic stroke, 16 (7.5%) were identified with dissection, 37.5% had warning symptoms, and 50% had a history of head or neck trauma. The clinical presentation included headache (44%), altered consciousness (25%), seizures (12.5%), and focal deficits (87.5%). Dissection involved extracranial vessels in 75% and anterior circulation in 56%. Follow-up included complete recovery in 43%, mild to moderate deficits in 44%, and severe deficits in 13%. Fourteen (87.5%) children received antithrombotic treatment. Follow-up angiography showed resolution of abnormalities in 60% of vessels. Total occlusion had the worst outcome for recanalization. In conclusion, the etiology of arterial dissection in the majority of children appears to be either trauma or idiopathic. Long-term angiography shows variable outcomes, depending on the initial findings. The relationship of angiographic outcomes with recurrent strokes requires further study in pediatric dissection. (J Child Neurol 2006;21:8-16).