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

Abstract

Little is known about long-term physical sequelae, cognitive functioning, and quality of life in children who have experienced ischemic stroke. Thirty-seven patients under 16 years of age were studied; the median interval after stroke was 7 years. CT-scans were reassessed to determine the type of infarction at baseline. Occurrences of death, of new cardiovascular events, and of seizures during follow-up were recorded. Surviving patients were invited for a follow-up examination, including physical check-up, global screening of cognition, and an inventory of subjective health perception. Only two patients were lost to follow-up. During follow-up four died, nine developed seizures, eight had transient ischemic attacks, and two experienced a recurrent ischemic stroke. None of the patients had cardiac complications during follow-up. In 11 of 27, no functional impairment was found, in 15 there was a hemiparesis of varying severity, and in one a paraplegia. There was a significant shift in cognitive functioning towards lower levels, especially in children with epilepsy. Remedial teaching was frequently needed. Many of the parents' perceived their child's behavior to be very changeable. Three-quarters of the children considered themselves as healthy as other children, and almost all of them as happy. The physical and functional prognosis after ischemic stroke in childhood is relatively good, particularly in children with no serious causative illness, but special education is often needed and social changes occur.

Ischemic stroke in children: a study of the associated alterations

“…Neurological impairments were the most prevalent types of evolution in our study, which in this agrees with other studies 8,14,22,25 . Epilepsy, however, had a high prevalence when compared to the studies of Moura-Ribeiro et al where the rate was 9.5% for children with cerebrovascular disease in general, which could suggest that AIS causes more epileptic alterations than haemorragic 25 .…”

“…The female sex was most affected in the present study with 52% of the cases contrary to the great majority of the other studies where the male sex represents between 50 and 60% of the cases 7,11,12,[14][15][16][17] . Perhaps this is due to the association of the male sex with arterial trauma dissection as a basic cause of AIS 18 , which did not occur in this study.…”

“…That the left side is the most affected agrees with the literature 8,10,14 . Ganesan et al found that hemiparesis was the most prevalent symptom in the initial phase (83%) followed by seizures (33%) in children with 3 months or more 13 .…”

“…However other diagnosis how methylenetetrahydrofolate reductase deficiency, for example, which are rare cause of AIS was not investigated in present study. AIS in children occurs predominately in the anterior circulation and the middle cerebral artery is the vessel most affected 8,9,14,18,[22][23][24] as is confirmed in this study. Cerebral AIS occurred in an adolescent who had osteosarcoma and patent foramen ovale; prior studies showed predominance of the male sex and the presence of patent oval forame in the cases of cerebellar strokes 25 .…”

Hemorrhagic Stroke in Children

“…Neurologic outcome after childhood arterial ischemic stroke has been reported by several groups [67][68][69]. Outcome after HS, however, has not been well studied in children.…”