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Pediatr Neurol. 2017 Apr;69:58-70. doi: 10.1016/j.pediatrneurol.2017.01.016. Epub 2017 Jan 26.

Epidemiology and Outcomes of Arterial Ischemic Stroke in Children: The Canadian Pediatric Ischemic Stroke Registry.

Author information

1
Division of Neurology, Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. Electronic address: gabrielle.deveber@sickkids.ca.
2
Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.
3
Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.
4
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
5
Department of Neurology, Mayo Clinic, Rochester, Minnesota.
6
Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
7
Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
8
Division of Neurology, Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
9
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
10
Department of Pediatrics, Queen's University, Kingston, Ontario, Canada.
11
Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
12
Department of Pediatrics, University of Western Ontario, London, Ontario, Canada.
13
Department of Pediatrics, University of Sherbrooke, Sherbrooke, Quebec, Canada.
14
Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
15
Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada.
16
Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland, Canada.
17
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.

Abstract

BACKGROUND:

Pediatric arterial ischemic stroke remains incompletely understood. Population-based epidemiological data inform clinical trial design but are scant in this condition. We aimed to determine age-specific epidemiological characteristics of arterial ischemic stroke in neonates (birth to 28 days) and older children (29 days to 18 years).

METHODS:

We conducted a 16-year, prospective, national population-based study, the Canadian Pediatric Ischemic Stroke Registry, across all 16 Canadian acute care children's hospitals. We prospectively enrolled children with arterial ischemic stroke from January 1992 to December 2001 and documented disease incidence, presentations, risk factors, and treatments. Study outcomes were assessed throughout 2008, including abnormal clinical outcomes (stroke-related death or neurological deficit) and recurrent arterial ischemic stroke or transient ischemic attack.

RESULTS:

Among 1129 children enrolled with arterial ischemic stroke, stroke incidence was 1.72/100,000/year, (neonates 10.2/100,000 live births). Detailed clinical and radiological information were available for 933 children (232 neonates and 701 older children, 55% male). The predominant clinical presentations were seizures in neonates (88%), focal deficits in older children (77%), and diffuse neurological signs (54%) in both. Among neonates, 44% had no discernible risk factors. In older children, arteriopathy (49% of patients with vascular imaging), cardiac disorders (28%), and prothrombotic disorders (35% of patients tested) predominated. Antithrombotic treatment increased during the study period (P < 0.001). Stroke-specific mortality was 5%. Outcomes included neurological deficits in 60% of neonates and 70% of older children. Among neonates, deficits emerged during follow-up in 39%. Overall, an initially decreased level of consciousness, a nonspecific systemic presentation, and the presence of stroke risk factors predicted abnormal outcomes. For neonates, predictors were decreased level of consciousness, nonspecific systemic presentation, and basal ganglia infarcts. For older children, predictors were initial seizures, nonspecific systemic presentation, risk factors, and lack of antithrombotic treatment. Recurrent arterial ischemic stroke or transient ischemic attack developed in 12% of older children and was predicted by arteriopathy, presentation without seizures, and lack of antithrombotic treatment. Emerging deficit was predicted by neonatal age at stroke and by cardiac disease.

CONCLUSIONS:

This national data set provides a population-based disease incidence rate and demonstrates the protective effect of antithrombotic treatment in older children, and frequent long-term emerging deficits in neonates and in children with cardiac disorders. Further clinical trials are required to develop effective age-appropriate treatments for children with acute arterial ischemic stroke.

KEYWORDS:

epidemiology; incidence; ischemic; pediatric; stroke

[Indexed for MEDLINE]

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