Seizures as a Presenting Symptom of Acute Arterial Ischemic Stroke in Childhood

Abend, Nicholas S.; Beslow, Lauren A.; Smith, Sabrina E.; Kessler, Sudha Kilaru; Vossough, Arastoo; Mason, S.; Agner, Shannon C.; Licht, Daniel J.; Ichord, Rebecca

doi:10.1016/j.jpeds.2011.02.004

Cited by 88 publications

(66 citation statements)

References 48 publications

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“…However, seizures are a common presenting feature of childhood stroke, 37 and moyamoya 38 is a common arteriopathic cause of childhood stroke, so these variables were maintained in the multivariable analyses for IS. Additional study is needed to determine whether the presentations or underlying causes of stroke are different among those admitted on weekends versus weekdays and how these features might contribute to the observed weekend effect.…”

Section: June 2016mentioning

confidence: 99%

Weekend Effect in Children With Stroke in the Nationwide Inpatient Sample

Adil

Vidal

Beslow

2016

Stroke

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Background and Purpose-Studies have demonstrated differences in clinical outcomes in adult patients with stroke admitted on weekdays versus weekends. The study's objective was to determine whether a weekend impacts clinical outcomes in children with ischemic stroke and hemorrhagic stroke. Methods-Children aged 1 to 18 years admitted to US hospitals from 2002 to 2011 with a primary discharge diagnosis of ischemic stroke or hemorrhagic stroke were identified by International Classification of Disease, 9th Revision, codes. Logistic regression estimated odds ratios and 95% confidence intervals for in-hospital mortality and discharge to a nursing facility among children admitted on weekends (Saturday and Sunday) versus weekdays (Monday to Friday), adjusting for potential confounders. Results-Of 8467 children with ischemic stroke, 28% were admitted on a weekend. Although children admitted on weekends did not have a higher in-hospital mortality rate than those admitted on weekdays (4.1% versus 3.3%; P=0.4), children admitted on weekends had a higher rate of discharge to a nursing facility (25.5% versus 18.6%; P=0.003). After adjusting for age, sex, and confounders, the odds of discharge to a nursing facility remained increased among children admitted on weekends (odds ratio, 1.5; 95% confidence interval, 1.1-1.9; P=0.006). Of 10 919 children with hemorrhagic stroke, 25.3% were admitted on a weekend. Children admitted on weekends had a higher rate of in-hospital mortality (12% versus 8%; P=0.006). After adjusting for age, sex, and confounders, the odds of in-hospital mortality remained higher among children admitted on weekends (odds ratio, 1.4; 95% confidence interval, 1.1-1.9; P=0.04). Conclusions-There seems to be a weekend effect for children with ischemic and hemorrhagic strokes. Quality improvement initiatives should examine this phenomenon prospectively.

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Section: June 2016mentioning

confidence: 99%

Weekend Effect in Children With Stroke in the Nationwide Inpatient Sample

Adil

Vidal

Beslow

2016

Stroke

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“…[62][63][64] In comparison, the incidence of seizures as a presenting symptom is B3% in adults with stroke. 65 While the recurrence risk in neonatal strokes is low, the risk of recurrence for older children is nearly 20%.…”

Section: Etiology and Patterns Of Pediatric Stroke Differ From Those mentioning

confidence: 99%

Mechanisms of Perinatal Arterial Ischemic Stroke

Fernández-López

Natarajan

Ashwal

et al. 2014

J Cereb Blood Flow Metab

110

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The incidence of perinatal stroke is high, similar to that in the elderly, and produces a significant morbidity and severe long-term neurologic and cognitive deficits, including cerebral palsy, epilepsy, neuropsychological impairments, and behavioral disorders. Emerging clinical data and data from experimental models of cerebral ischemia in neonatal rodents have shown that the pathophysiology of perinatal brain damage is multifactorial. These studies have revealed that, far from just being a smaller version of the adult brain, the neonatal brain is unique with a very particular and age-dependent responsiveness to hypoxia-ischemia and focal arterial stroke. In this review, we discuss fundamental clinical aspects of perinatal stroke as well as some of the most recent and relevant findings regarding the susceptibility of specific brain cell populations to injury, the dynamics and the mechanisms of neuronal cell death in injured neonates, the responses of neonatal blood-brain barrier to stroke in relation to systemic and local inflammation, and the long-term effects of stroke on angiogenesis and neurogenesis. Finally, we address translational strategies currently being considered for neonatal stroke as well as treatments that might effectively enhance repair later after injury.

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“…[5][6][7] Seizures in 22% to 25% at pediatric stroke onset (10-fold increase over adults) confound stroke diagnosis, accelerate ischemic injury, and entail urgent consideration of anticonvulsants for neuroprotection. 8,9 Studies to date, however, report intervals of 16 to 25 hours from symptom onset to stroke diagnosis 1,8,[10][11][12][13][14] far beyond 4.5 to 6 hours, the time window recommended for thrombolysis or embolectomy in adults. 2,15 In adult stroke centers, comprehensive stroke protocols increase access to stroke treatment, decreasing costs, and improving outcomes.…”

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confidence: 99%

A pediatric institutional acute stroke protocol improves timely access to stroke treatment

Shack

Andrade

Shah-Basak

et al. 2016

Develop Med Child Neuro

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AISArterial RESULTS Overall, the interval from symptom onset to diagnosis was similar post-protocol compared to pre-protocol (20.3 vs 22.7h; p=0.109), although mild strokes (Pediatric National Institute of Health Stroke Scale [PedNIHSS] 0-4), were diagnosed faster post-protocol (12.1 vs 36.3h; p=0.003). Magnetic resonance imaging (MRI) was the initial diagnostic modality more often post-protocol (25% vs 1.4%; p<0.001). Initial MRI was more accurate for diagnosing stroke than initial CT (100% vs 47%; p<0.001) with similar time-to-diagnosis. The proportion of children receiving antithrombotic medication within 24 hours doubled in the post-protocol period (83% vs 36%; p<0.001).

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Seizures as a Presenting Symptom of Acute Arterial Ischemic Stroke in Childhood

Cited by 88 publications

References 48 publications

Weekend Effect in Children With Stroke in the Nationwide Inpatient Sample

Weekend Effect in Children With Stroke in the Nationwide Inpatient Sample

Mechanisms of Perinatal Arterial Ischemic Stroke

A pediatric institutional acute stroke protocol improves timely access to stroke treatment

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