Stroke and nonstroke brain attacks in children

Mackay, Mark T; Chua, Zhi Kai; Lee, Michelle; Yock‐Corrales, Adriana; Чурилов, Леонид; Monagle, Paul; Donnan, Geoffrey A.; Babl, Franz E

doi:10.1212/wnl.0000000000000343

Cited by 93 publications

(66 citation statements)

References 29 publications

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“…Children presenting with abrupt onset focal deficits harbor non-stroke conditions in 21-90% [43] including migraine (28%), seizures (15%), Bell palsy (10%), stroke (7%) and conversion disorders (6%) [44] . Therefore, imaging confirmation is required in pediatric stroke diagnosis unlike in adult stroke where the clinical diagnosis (not pathological diagnosis of stroke types) is based on the WHO criteria.…”

Section: Discussionmentioning

confidence: 99%

Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Children and Youth Aged 0-19 Years: Data from the Global and Regional Burden of Stroke 2013

et al. 2015

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Background: There is increasing recognition of stroke as an important contributor to childhood morbidity and mortality. Current estimates of global childhood stroke burden and its temporal trends are sparse. Accurate and up-to-date estimates of childhood stroke burden are important for planning research and the resulting evidence-based strategies for stroke prevention and management. Objectives: To estimate the prevalence, mortality and disability-adjusted life years (DALYs) for ischemic stroke (IS), hemorrhagic stroke (HS) and all stroke types combined globally from 1990 to 2013. Methodology: Stroke prevalence, mortality and DALYs were estimated using the Global Burden of Disease 2013 methods. All available data on stroke-related incidence, prevalence, excess mortality and deaths were collected. Statistical models and country-level covariates were employed to produce comprehensive and consistent estimates of prevalence and mortality. Stroke-specific disability weights were used to estimate years lived with disability and DALYs. Means and 95% uncertainty intervals (UIs) were calculated for prevalence, mortality and DALYs. The median of the percent change and 95% UI were determined for the period from 1990 to 2013. Results: In 2013, there were 97,792 (95% UI 90,564-106,016) prevalent cases of childhood IS and 67,621 (95% UI 62,899-72,214) prevalent cases of childhood HS, reflecting an increase of approximately 35% in the absolute numbers of prevalent childhood strokes since 1990. There were 33,069 (95% UI 28,627-38,998) deaths and 2,615,118 (95% UI 2,265,801-3,090,822) DALYs due to childhood stroke in 2013 globally, reflecting an approximately 200% decrease in the absolute numbers of death and DALYs in childhood stroke since 1990. Between 1990 and 2013, there were significant increases in the global prevalence rates of childhood IS, as well as significant decreases in the global death rate and DALYs rate of all strokes in those of age 0-19 years. While prevalence rates for childhood IS and HS decreased significantly in developed countries, a decline was seen only in HS, with no change in prevalence rates of IS, in developing countries. The childhood stroke DALY rates in 2013 were 13.3 (95% UI 10.6-17.1) for IS and 92.7 (95% UI 80.5-109.7) for HS per 100,000. While the prevalence of childhood IS compared to childhood HS was similar globally, the death rate and DALY rate of HS was 6- to 7-fold higher than that of IS. In 2013, the prevalence rate of both childhood IS and HS was significantly higher in developed countries than in developing countries. Conversely, both death and DALY rates for all stroke types were significantly lower in developed countries than in developing countries in 2013. Men showed a trend toward higher childhood stroke death rates (1.5 (1.3-1.8) per 100,000) than women (1.1 (0.9-1.5) per 100,000) and higher childhood stroke DALY rates (120.1 (100.8-143.4) per 100,000) than women (90.9 (74.6-122.4) per 100,000) globally in 2013. Conclusions: Globally, between 1990 and 2013, there was a significa...

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Section: Discussionmentioning

confidence: 99%

Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Children and Youth Aged 0-19 Years: Data from the Global and Regional Burden of Stroke 2013

et al. 2015

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“…Many children with stroke-like symptoms will have other nonstroke diagnoses, 1,2 and even at primary pediatric stroke centers, readiness for rapid acute stroke care is challenging. 3 Therefore, an interdisciplinary team at our tertiary children's hospital developed a pediatric stroke team in 2011 (online-only Data Supplement) with leadership from Pediatric Emergency Medicine, Critical Care Medicine, Neurology, and Radiology.…”

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confidence: 99%

Pediatric Acute Stroke Protocol Activation in a Children’s Hospital Emergency Department

Ladner

Mahdi

Gindville

et al. 2015

Stroke

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Background and Purpose-Pediatric acute stroke teams are a new phenomenon. We sought to characterize the final diagnoses of children with brain attacks in the emergency department where the pediatric acute stroke protocol was activated and to describe the time to neurological evaluation and neuroimaging. Methods-Clinical and demographic information was obtained from a quality improvement database and medical records for consecutive patients (age, ≤20 years) presenting to a single institution's pediatric emergency department where the acute stroke protocol was activated between April 2011 and October 2014. Stroke protocol activation means that a neurology resident evaluates the child within 15 minutes, and urgent magnetic resonance imaging is available. Results-There were 124 stroke alerts (age, 11.2±5.2 years; 63 boys/61 girls); 30 were confirmed strokes and 2 children had a transient ischemic attack. Forty-six of 124 (37%) cases were healthy children without any significant medical history. Nonstroke neurological emergencies were found in 17 children (14%); the majority were meningitis/encephalitis (n=5) or intracranial neoplasm (n=4). Other common final diagnoses were complex migraine (17%) and seizure (15%). All children except 1 had urgent neuroimaging. Magnetic resonance imaging was the first study in 76%. The median time from emergency department arrival to magnetic resonance imaging was 94 minutes (interquartile range, 49-151 minutes); the median time to computed tomography was 59 minutes (interquartile range, 40-112 minutes). Conclusions-Of pediatric brain attacks, 24% were stroke, 2% were transient ischemic attack, and 14% were other neurological emergencies. Together, 40% had a stroke or other neurological emergency, underscoring the need for prompt evaluation and management of children with brain attacks.

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“…Children present age-related challenges to timely diagnosis, including stroke mimics in 30% to 75% and subtle clinical presentations, which necessitates neuroimaging confirmation of stroke before administering treatment. [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.…”

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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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Stroke and nonstroke brain attacks in children

Abstract: Brain attack etiologies differ from adults, with stroke being the fourth most common diagnosis. These findings will inform development of ED clinical pathways for pediatric brain attacks.

Cited by 93 publications

References 29 publications

Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Children and Youth Aged 0-19 Years: Data from the Global and Regional Burden of Stroke 2013

Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Children and Youth Aged 0-19 Years: Data from the Global and Regional Burden of Stroke 2013

Pediatric Acute Stroke Protocol Activation in a Children’s Hospital Emergency Department

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

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