Akut Arterial İskemik İnmesi Olan Çocuklarda Risk Faktörleri ve Nörolojik Bulgular

Amaç: Çalışmamızın amacı arterial iskemik inmesi (Aİİ) olan çocuklarda klinik özellikler, tedavi seçenekleri ve prognozun saptanmasıdır.

Anahtar Kelimeler:

Arterial iskemik inme, çocuk

Risk Factors and Neurologic Outcomes in Childhood Arterial Ischemic Stroke

Objective: The aim of this study is to describe clinical characteristics, treatment modalities and outcomes of children with arterial ischemic stroke (AIS). Material and Methods: We retrospectively reviewed the charts of 102 children (62 girls and 40 boys) with AIS admitted at our hospital between 2009 and 2015. Age at stroke, sex, medical history, family history, clinical findings upon admission, history of seizure, and radiological findings were recorded. Cardiac assessment, hematological and immunological tests, metabolic screening were all performed in the patients. Results: In 25 children stroke occured as a complication of cardiac disease, 12 had transient cerebral arteriopathy, 11 had Down’s syndrome, 9 had thalassemia, 7 had moyamoya disease, 6 had MTHFR mutation, 4 had homozygote for factor V Leiden, 3 had protein C deficiency, 1 had sickle cell disease, and in 24 children no underlying cause could be found. Multiple risk factors were found in 16 children and recurrent stroke was observed in 4 patients. Hemiplegia was the commonest initial clinical presentation (88.2%) followed by seizure (66.6%) and decreased level of consciousness (54.9%). The avarage length of follow-up was 32.1±5.4 months. The outcome in all 102 stroke patients was as follows: asymptomatic 57.8%; persistent neurologic deficit or epilepsy 40.2%; and death 2%. Conclusion: Our study showed an underlying cause for AIS in 76.5% of the patients; 42.2% of the patients either died or had motor and/or cognitive sequelae and recurrence occured despite prophylactic aspirin treatment in 4 patients.

Keywords:

Arterial Ischemic Stroke, children,

PDF

___

1. Roach ES, Golomb MR, Adams R, Biller J, Daniels S, Deveber G, Ferriero D, Jones BV, Kirkham FJ, Scott RM, Smith ER.. A scientific statement from a special writing group of the American Heart Association Stroke Council and the Council of Cardiovascular Disease in the Young. Stroke. 2008;39: 2644-91.
2. de Veber G, Roach ES, Riela AR, Wiznitzer M. Stroke in children: recognition, treatment, and future directions. Semin Pediatr Neurol 2000;7:309-17.
3. Simma B, Martin G, Müller T, Huemer M. Risk factors for pediatric stroke: consequences for therapy and quality of life. Pediatr Neurol. 2007;37:121-6.
4. Touré A, Chabrier S, Plagne MD, Presles E, des Portes V, Rousselle C. Neurological outcome and risk of recurrence depending on the anterior vs.posterior arterial distribution in children with stroke. Neuropediatrics. 2009;40:126-8.
5. Westmacott R, Askalan R, MacGregor D, Anderson P, Deveber G. Cognitive outcome following unilateral arterial ischaemic stroke in childhood:effects of age at stroke and lesion location. Dev Med Child Neurol. 2010;52:386-93.
6. Incecik F, Ozlem Hergüner M, Altunbasak S. Risk factors and treatment outcomes for children with arterial ischemic stroke. J Clin Neurosci. 2010;17:1000-2.
7. Lopez-Vicente M, Ortega-Gutierrez S, Amlie-Lefond C, Torbey MT. Diagnosis and management of pediatric arterial ischemic stroke. J Stroke Cerebrovasc Dis. 2010;19:175-83.
8. M. Steinlin, I. Pfister, J. Pavlovic, Everts R, Boltshauser E, Capone Mori A, Gubser Mercati D, Hänggeli CA, Keller E. The first three years of the Swiss Neuropaediatric Stroke Registry (SNPSR): a population-based study of incidence, symptoms and risk factors. Neuropediatrics. 2005;36: 90–97.
9. Tham EH, Tay SK, Low PS. Factors predictive of outcome in childhood stroke in an Asian population. Ann Acad Med Singapore. 2009;38:876-81.
10. Kleindorfer D, Khoury J, Kissela B, Alwell K, Woo D, Miller R, Schneider A, Moomaw C, Broderick JP. Temporal trends in the incidence and case fatality of stroke in children and adolescents. J Child Neurol. 2006;21:415-8.
11. Zahuranec DB, Brown DL, Lisabeth LD, Morgenstern LB. Is it time for a large, collaborative study of pediatric stroke? Stroke. 2005;36:1825-9.
12. Neil Friedman. Pediatric cardiovascular disease and stroke. J Pediatr Neurol. 2010;8: 259-265 259.
13. Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent childhood arterial ischemic stroke in a population-based cohort: the importance of cerebrovascular imaging. Pediatrics. 2007; 119:495–501.
14. Braun KP, Bulder MM, Chabrier S, Kirkham FJ, Uiterwaal CS, Tardieu M, Sébire G. The course and outcome of unilateral intracranial arteriopathy in 79 children with ischaemic stroke. Brain 2009; 132:544-557.
15. Miravet E, Danchaivijitr N, Basu H, Saunders DE, Ganesan V. Clinical and radiological features of childhood cerebral infarction following varicella zoster virus infection. Dev Med Child Neurol 2007;49:417-422.
16. Amlie-Lefond C, Bernard TJ, Sébire G, Friedman NR, Heyer GL, Lerner NB, DeVeber G, Fullerton HJ. Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study. Circulation. 2009;119:1417-23.
17. Goldenberg NA, Bernard TJ, Fullerton HJ, Gordon A, deVeber G. Antithrombotic treatments, outcomes, and prognostic factors in acute childhoodonset arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol 2009;8:1120-1127.
18. Monagle P, Chalmers E, Chan A, Veber G, Kirkham F, Massicotte P, Michelson AD. Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2008;133:887-968.
19. Christerson S, Strömberg B. Stroke in Swedish children II: long-term outcome.Acta Paediatr. 2010;99:1650-6.