Does time and experience matter in pediatric arterial ischemic stroke intervention? Long term follow up experience

Abstract

Introduction: Acute ischemic stroke is an important cause of mortality in childhood with variable long term neurological sequelae. This study presents long term follow up outcome data of our center which is a tertiary clinic with a well-organized pediatric stroke team. Method: Medical records of patients diagnosed at pediatric age (28 days-18 years) with acute ischemic stroke between years 2011-2018 in Marmara University Pediatric Neurology Clinic were retrospectively evaluated. Patients whose initial medical intervention was performed by Marmara University Pediatric Emergency unit and had been followed by our clinic for at least 5 years after initial diagnoses were included in this study. The modified Rankin Scale(mRS) and Pediatric Stroke Outcome Measure Short Neuro Exam (PSE-SEN) were performed to all of the patients in addition to final neurological examination. Results: The mean first ischemic stroke age of 32 patients (20 male,62,5%) included in the study was 77,39±61,93 months. First stroke age was grouped as early (≤60 months; n=16) and late (>61 months, n=16). The median time passed from initial symptom to emergency room admission was 15,5 (1-720) hours. The mean follow-up interval of the study group was 85,44±20,52 months and the mean age of the group at the time of the study (present age) was 162,62±64,4 months. Affected vascular territory did not have any significant effect on long-term clinical outcomes (p=0,550). Late stroke age group (>61 months) had a significantly higher rate of normal functional long-term outcome(p=0.023). The younger age group (≤60 months) had longer hospital admission time (24 h vs 9 h). PSOM scores were helpful to detect some mild cognitive and language dysfunctions that did not interfere with daily life. Conclusion: Pediatric Stroke Outcome Measure Short Neuro Exam (PSE-SEN) is helpful to catch mild neurocognitive sequela that can be missed with neurological examination. Considering the fact that time after first symptom is critical for early intervention in acute ischemic stroke patients, stroke teams should be settled in all centrally located medical centers with easy transportation opportunities.