Cerebrovascular disease in children

Abstract

Stroke although rare in children, is an important cause of morbidity in the paediatric age group. Over a period of 8 years, 43 children (17 boys and 26 girls) in the age groups of 1–16 years (mean 8.02 yrs) presented with stroke which constituted 10% of all strokes in the young and 0.7% of all paediatric admissions. The chief clinical features were hemiplegia (86%), convulsions (27%), fever (23%). dysphasia (23%), headache (11%) and altered level of consciousness (11%). Routine laboratory tests were non‐contributory. Cranial computerized tomography (CCT) on 21 patients was abnormal in 95% and was useful in revealing the extent of infarction. Infarction was confined to middle cerebral artery territory, often involving basal ganglionic structures and was associated with focal or diffuse atrophy. Angiograms were abnormal in 78% of the patients (18/23) and were complimentary to the CCT. Etiological factors identified were: Moya‐moya disease 6, arteritis 5, fibromuscular dysplasia 2, scorpion sting 2, and venous sinus thrombosis and small vessel occlusion one each. Though 23% of the patients had fever at onset, no obvious evidence of systemic or CNS infection was noticed. Stroke in children continues to pose a diagnostic challenge.

Management of Stroke in Infants and Children

“…115,116 In Japan, it is the most common pediatric cerebrovascular disease, affecting girls almost twice as often as boys with a prevalence of Ϸ3 of 100 000. 111,117 In Europe, a recent study cited an incidence of 0.3 patients per center per year, which is Ϸ1/10 the incidence in Japan. 118 Results from a 2005 US study suggest an incidence of 0.086 of 100 000 persons.…”

“…Half of the patients present before 10 years of age. 111,112 Some patients have rare, intermittent ischemic events or even extended periods of clinical stability; other individuals have a more fulminant rapid neurological decline. 113,114 Children with moyamoya typically present with ischemic stroke or TIAs.…”

Understanding and treating moyamoya disease in children

“…123 Moyamoya disease affects both males and females; however, in most series there is a consistent female preponderance, with females being affected nearly twice as often as males. 5,73,91 In addition, there is a bimodal age distribution, with patients typically presenting either in the 1st or 4th decade of life. 51,99 For those presenting within the 1st decade, ischemic events such as TIAs or strokes are more common.…”

Cerebrovascular manifestations following scorpion sting

“…DIC also can cause cerebrovascular manifestations. [8][9][10][11][12] Scorpion envenomation considered a major public health problem in rural parts of India. Appropriate clothing, shoes could prevent the incidence of scorpion sting.…”