Clinical survey of ischemic cerebrovascular disease in children in a district of Japan.

Abstract

Ischemic cerebrovascular disease in children is relatively rare. To clarify the clinical features of ischemic stroke occurring in infants and children, we evaluated 54 cases of cerebral infarction, excluding cases of moyamoya disease, in patients < 16 years old at 24 clinics in the Tohoku (northeast) district of Japan. We observed two incidence peaks, one in little children and the other in junior high school students. Infection and minor head trauma were more frequently seen prior to ischemic strokes than was heart disease. The middle cerebral artery region, including the basal ganglia, was most commonly affected (49 patients, 91%) on computed tomograms. Angiography was performed in 48 patients (89%) and showed various types of occlusive lesions, mostly affecting the middle cerebral artery. Hemiparesls was the most common form of disability following ischemic strokes (48 patients, 89%). Surgical treatment was carried out in seven patients (13%). The clinical course of these cases showed that the recovery of children after a stroke tends to be better than that of adults, but that permanent disabilities, such as hemiparesis or mental retardation, occur commonly. Further investigation of juvenile cerebrovascular disease is important to prevent ischemic strokes in children. (Stroke 1991;22:586-589)

Prognosis of ischemic stroke in childhood: a long‐term follow‐up study

“…Ischemic lesions in the basal ganglia after minor head injury have been reported previously (Dharker et al 1993), with similar findings about location and good prognosis. In accordance with Satoh and coworkers (Satoh et al 1991), we did not find a high rate of heart disease (Schoenberg et al 1978, Roach et al 1984, Riela and Roach 1993.…”

“…Its incidence was reported to be 1.2 per 100 000 in a recent study in a metropolitan population of children under 15 years of age (Williams et al 1997) and 7.9 per 100 000 between 1985 and 1993 in a population-based study of children under 16 years of age (Giroud et al 1995). Causes and clinical features of stroke in childhood have been studied before (Blennow et al 1978, Schoenberg et al 1978, Eeg Olofsson and Ringheim 1983, Isler 1984, Roach et al 1984, Dusser et al 1986, Lanska et al 1991, Satoh et al 1991, Riela and Roach 1993, Powell et al 1994, Giroud et al 1995, but only a few of these studies have dealt with ischemic strokes (Blennow et al 1978, Dusser et al 1986, Satoh et al 1991, Powell et al 1994. In general, children tend to recover better from a stroke than adults (Roach et al 1984, Nicolaides andAppleton 1996), but more information is required on long-term outcome.…”

Inherited and acquired risk factors and their combined effects in pediatric stroke

“…Five of the eight patients with seizures at the onset of stroke later developed epilepsy. Disabilities were as frequent in our patients (47.6%) as reported by others [7]. Recurrence of stroke occurred in five patients (23.8%), a frequency similar to previous reports [5,11,14].…”

“…Several conditions have been associated with stroke, including cardiac disease, vascular abnormalities, endothelial damage, infectious diseases, collagen tissue disease, and some inborn errors of metabolism and inherited or acquired coagulation abnormalities that predispose to thrombotic complications. Reported prothrombotic abnormalities include anticardiolipin antibody, lupus anticoagulant, deficiencies of protein C, protein S, antithrombin, and plasminogen [1,[5][6][7][8][9][10][11]. New hypercoagulable states are being identified as risk factors for ischemic stroke in childhood: the presence of abnormal activated protein C resistance (or Factor V Leiden), Factor II G20219A variant, and thermolabile variant of methylenetetrahydrofolate reductase (MTHFR C677T) [8][9][10][11][12][13].…”

Childhood Posterior Circulation Ischemic Stroke: An Uncommon Cerebrovascular Disease. Case Report

“…It presents an incidence ranging from 0.2 to 7.9/100,000 children/year with a mortality rate reaching 0.6 to 5.3/100,000 pediatric strokes/year. More than half of the survivors will develop some neurologic or cognitive deficit creating an important social and economic problem (5)(6)(7)(8)(9) . However, posterior circulation ischemic stroke is an uncommon cerebrovascular event in pediatric population with limited published data on English literature regarding the possible risk factors and outcomes (10)(11) .…”