Etiologic Profile of Childhood Stroke from North India: Is It Different from Developed World?

Abstract

Objective: To describe the etiology of childhood arterial-ischemic stroke from a developing country and assess short-term neurologic outcome. Methods: Prospective observational study. Consecutive children between the age of >28 days to <12 years, admitted with the diagnosis of arterial-ischemic stroke were enrolled during the study period from January 2017 to December 2018. Short-term neurologic outcome was assessed with Pediatric Cerebral Performance Category (PCPC) scale and Pediatric Stroke Outcome Measure (PSOM). Results: We enrolled 76 children with arterial-ischemic stroke, with a median age of 24 months (interquartile range 12-69), and 43 (57%) were boys. The most common risk factor for childhood arterial-ischemic stroke was arteriopathy in 59 (77%), followed by cardiovascular disorder in 12 (16%) children. Among 59 children with arteriopathy, 32 (42%) had infection-associated arteriopathies, 10 (13%) had mineralizing angiopathy, 10 (13%) had moyamoya disease. Pediatric stroke risk factors were classified according to Pediatric Stroke Classification and CASCADE primary classification. Short-term neurologic outcome was assessed at 3 months in 62 (82%) survivors. Among stroke survivors, 33 (61%) had sensory-motor deficits, and 24 (39%) had severe neurologic disability (PCPC ≥ 4). The presence of fever, encephalopathy, low Glasgow coma score at presentation, seizures, and infection-associated arteriopathy predicted severe neurologic disability at follow-up. Conclusion: The risk factors for pediatric arterial-ischemic stroke are different from developed countries in our cohort. Infection-associated arteriopathies, mineralizing angiopathy, and moyamoya disease are the most common risk factors in our cohort. Two-thirds of pediatric stroke survivors have neurologic disability at short-term follow-up.

Childhood stroke: A prospective study on risk factors, clinical profile, and short-term outcome in a tertiary care hospital in Eastern India

“…The majority achieved partial recovery in case of AIS (86.9%) and HS (71.4%), although CSVT (n=12) had a significantly higher prevalence of complete recovery (83%, p =0.000) (Table 4). 12 found that vascular disorder was the commonest risk factor for AIS whereas Chand P, et al 13 found cardiac disease as the commonest risk factor. In CSVT (n=12), the commonest risk factor was infection (67%) followed by haematological disorder (25%) which was consistent with study by Sebire G, et al 14 .…”

“…Overall, commonest presentation was seizure (78%) followed by hemiparesis (70%). Parakh M, et al 10 and Chand P, et al 12 found that seizure was the commonest presentation but Patra C, et al 4 and Lee EH et al 8 reported hemiparesis as commonest presentation followed by seizure. Among AIS (n=23) commonest presentation was hemiparesis (95%) which was similar to studies by Jeong J, et al 9 and Mallick AA, et al 18 .…”