Acute ischemic stroke in children versus young adults

Bigi, Sandra; Fischer, Urs; Wehrli, Edith; Mattle, Heinrich; Boltshauser, Eugen; Bürki, Sarah; Jeannet, Pierre-Yves; Fluss, Joël Victor; Weber, Peter; Nedeltchev, Krassen; El-Koussy, Marwan; Steinlin, Maja; Arnold, Marcel

doi:10.1002/ana.22427

Cited by 149 publications

(105 citation statements)

References 27 publications

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“…performed combined bypass surgery on 61 pediatric patients with moyamoya disease at Kyoto University Hospital in Kyoto, Japan, and its satellite hospital. The senior author created a personal database by collecting data on these consecutive cases including patient identification number, age at admission, sex, age at symptom onset, primary clinical manifestations at onset, clinical condition at admission (translated later into the modified Rankin scale [mRS] score with age-specific modification 2,37 ), date and procedure of surgery, and angiographic findings upon each patient's first or second admission. These patients were followed prospectively at our hospital.…”

Section: Patient Populationmentioning

confidence: 99%

Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease

Funaki

Takahashi

Takagi

et al. 2013

PED

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Object In the study of pediatric moyamoya disease, information on long-term social outcomes and risk factors for unfavorable social outcomes remains insufficient. The authors analyzed the long-term results of surgical revascularization for pediatric patients with moyamoya disease to determine whether the involvement of a stenoocclusive lesion in the posterior cerebral artery (PCA), relatively common in pediatric moyamoya disease, represents an underlying predictor for unfavorable social outcomes. Methods Prospectively collected data on 61 consecutive patients with moyamoya disease who had undergone combined bypass surgery were analyzed. Neuroradiological features and other baseline clinical factors were incorporated into univariate and multivariate analyses to determine any association with an unfavorable social outcome, defined as difficulty attending regular school or obtaining regular employment. Results Posterior cerebral artery involvement detected by angiography on admission was noted in 22 (36.1%) of the 61 patients. Follow-up data were acquired in 56 patients (91.8%), and the mean follow-up period was 15.8 years. While transient ischemic attacks were eliminated in 52 (92.9%) of these 56 patients after surgery, and late-onset ischemic stroke was observed in only 1 patient during the follow-up period, 10 (17.9%) experienced an unfavorable social outcome. Although younger age at onset, longer duration between onset and surgery, infarction present on preoperative neuroradiological images, and PCA involvement had been identified as risk factors for an unfavorable social outcome in univariate analysis, only infarction present on preoperative images and PCA involvement remained statistically significant after multivariate adjustment. Conclusions Posterior cerebral artery involvement can be considered one of the underlying risk factors for unfavorable social outcome and should be studied further to improve social outcome in pediatric moyamoya disease.

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Section: Patient Populationmentioning

confidence: 99%

Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease

Funaki

Takahashi

Takagi

et al. 2013

PED

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“…• In a prospective Swiss registry, 221 atherosclerotic risk factors were less common in children with arterial ischemic stroke than in young adults; the most common of these factors in children was hyperlipidemia (15%). However, an analysis of the Nationwide Inpatient Sample suggests a low but rising prevalence of these factors among US adolescents and young adults hospitalized for ischemic stroke (1995 versus 2008).…”

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confidence: 99%

Prevalence of Excess Sodium Intake in the United States — NHANES, 2009–2012

Jackson¹,

King²,

Zhao³

et al. 2016

MMWR Morb. Mortal. Wkly. Rep.

122

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“…The understanding that MTS occurs remotely from prior areas of infarction and is involved in the epileptic network contributing to medically intractable epilepsy is well recognized. 5,18,19 Hemispherotomy certainly circumvents the problem of widespread epileptogenic networks in the setting of early vascular injury and is one of the most effective forms of epilepsy surgery across all etiologies, with seizure freedom rates as high as more than 90%. 1,35,36 Hemispheric disconnection/anatomical resection has been the mainstay of surgical therapy for large perinatal porencephalic cysts after MCA stroke.…”

Section: Discussionmentioning

confidence: 99%

“…The degree of disability or dependence in daily activities was assessed using the modified Rankin Scale (mRS) for stroke patients, adapted to evaluate children as well as adults, and scored as follows: no symptoms at all (0); able to carry out all usual activities despite symptoms, normal development (1); unable to carry out all activities but has age-appropriate independence and no reduction in gross motor skills (2); requiring some help but able to walk without assistance, reduction of 1 level in gross motor skills in younger children (3); unable to walk without assistance but able to attend to own bodily needs, or reduction of at least 2 levels in motor skill development (4); and bedridden, incontinent, requiring constant care (5). 5,37 Seizure category was assigned based on the updated International League Against Epilepsy classification, 4 or for patients evaluated prior to the revision of guidelines, retrospectively classified using current terminology. Medically refractory epilepsy has been defined as epilepsy resistant to two separate singleagent antiepileptic drugs (AEDs), 30,31 but in all cases in our series, multiple single and multiple polytherapy drug trials had been attempted prior to surgery.…”

Section: Data Collectionmentioning

confidence: 99%

Surgical management of medically refractory epilepsy due to early childhood stroke

Ghatan

McGoldrick

Palmese

et al. 2014

PED

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Object The risk of developing epilepsy after perinatal stroke, hypoxic/ischemic injury, and intracerebral hemorrhage is significant, and seizures may become medically refractory in approximately 25% of these patients. Surgical management can be difficult due to multilobar or bilateral cortical injury, nonfocal or poorly lateralizing video electroencephalography (EEG) findings, and limited functional reserve. In this study the authors describe the surgical approaches, seizure outcomes, and complications in patients with epilepsy due to vascular etiologies in the perinatal period and early infancy. Methods The records were analyzed of 19 consecutive children and adults with medically refractory epilepsy and evidence of perinatal arterial branch occlusions, hypoxic/ischemic insult, or hemorrhagic strokes, who underwent surgery at the Comprehensive Epilepsy Center of Beth Israel Medical Center and St. Luke's-Roosevelt Hospital Center. Preoperative findings including MRI, video EEG, functional MRI, and neuropsychological testing were analyzed. The majority of patients underwent staged operations with invasive mapping, and all patients had either extra- or intraoperative functional mapping. Results In 7 patients with large porencephalic cysts due to major arterial branch occlusions, periinsular functional hemispherotomy was performed in 4 children, and in 3 patients, multilobar resections/disconnections were performed, with 1 patient undergoing additional resections 3 years after initial surgery due to recurrence of seizures. All of these patients have been seizure free (Engel Class IA) after a mean 4.5-year follow-up (range 15–77 months). Another 8 patients had intervascular border-zone ischemic infarcts and encephalomalacia, and in this cohort 2 hemispherotomies, 5 multilobar resections/disconnections, and 1 focal cortical resection were performed. Seven of these patients remain seizure free (Engel Class IA) after a mean 4.5-year follow-up (range 9–94 months), and 1 patient suffered a single seizure after 2.5 years of seizure freedom (Engel Class IB, 33-month follow-up). In the final 4 patients with vascular malformation-associated hemorrhagic or ischemic infarction in the perinatal period, a hemispherotomy was performed in 1 case, multilobar resections in 2 cases, and in 1 patient a partial temporal lobectomy was performed, followed 6 months later by a complete temporal and occipital lobectomy due to ongoing seizures. All of these patients have had seizure freedom (Engel Class IA) with a mean follow-up of 4.5 years (range 10–80 months). Complications included transient monoparesis or hemiparesis in 3 patients, transient mutism in 1 patient, infection in 1 patient, and a single case of permanent distal lower-extremity weakness. Transient mood disorders (depression and anxiety) were observed in 2 patients and required medical/therapeutic intervention. Conclusions Epilepsy surgery is effective in controlling medically intractable seizures after perinatal vascular insults. Seizure foci tend to be widespread and rarely limited to the area of injury identified through neuroimaging, with invasive monitoring directing multilobar resections in many cases. Long-term functional outcomes have been good in these patients, with significant improvements in independence, quality of life, cognitive development, and motor skills, despite transient postoperative monoparesis or hemiparesis and occasional mood disorders.

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Acute ischemic stroke in children versus young adults

Abstract: Although stroke etiology and risk factors in children and young adults are different, stroke severity and clinical outcome were similar in both groups.

Cited by 149 publications

References 27 publications

Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease

Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease

Prevalence of Excess Sodium Intake in the United States — NHANES, 2009–2012

Surgical management of medically refractory epilepsy due to early childhood stroke

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