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Journal of Pediatric Neurology 2021; 19(03): 161-165
DOI: 10.1055/s-0040-1701204
Original Article

Predictors of Neurological Outcome of Arterial Ischemic Stroke in Children

Tatia Aprasidze 
1   Department of Medicine, David Tvildiani Medical University, Tbilisi, Georgia
2   Department of Neuroscience, M. Iashvili Children's Central Hospital, Tbilisi, Georgia
,
Nana Tatishvili 
1   Department of Medicine, David Tvildiani Medical University, Tbilisi, Georgia
2   Department of Neuroscience, M. Iashvili Children's Central Hospital, Tbilisi, Georgia
,
Teona Shatirishvili 
1   Department of Medicine, David Tvildiani Medical University, Tbilisi, Georgia
2   Department of Neuroscience, M. Iashvili Children's Central Hospital, Tbilisi, Georgia
,
Giorgi Lomidze 
3   Department of Epilepsy, Institute of Neurology and Neuropsychology, Tbilisi, Georgia
› Author Affiliations Funding This work was supported by Shota Rustaveli National Science Foundation Grant N°PhD_F_17_121.
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Abstract

Stroke is an important cause of mortality and morbidity in children. The aim of the study was to evaluate long-term neurological outcome in children with arterial ischemic stroke (AIS) and explore predictive factors that affect poor outcome. Fifty-six patients aged between 1 month and 17 years who were treated at M. Iashvili Children's Central Hospital, Tbilisi, Georgia, with an onset of stroke from 2007 to 2017 were included. To explore predictive factors of outcome, the following data were collected: demographic characteristics, risk factors, he presenting signs, radiological features, and presence of stroke recurrence. Neurological status at discharge and long-term neurological outcome at least 1 year after stroke was evaluated according to Pediatric Stroke Outcome Measure subscale. The reported outcome after childhood stroke was variable with long-term neurological deficits in one-third of patients (30.4%). The neurological outcome was worse in males, in patients with multiple stroke episodes, and in those with infarctions involving a combination of cortical and subcortical areas. Pediatric AIS carries the risk of long-term morbidity, and neuroimaging has a predictive influence on outcome.

Keywords

predictors of outcome - pediatric stroke - arterial ischemic stroke


Publication History

Received: 11 November 2019

Accepted: 12 December 2019

Article published online:
09 February 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Lagman-Bartolome AM, Pontigon AM, Moharir M. et al. Basilar artery strokes in children: good outcomes with conservative medical treatment. Dev Med Child Neurol 2013; 55 (05) 434-439
    CrossrefPubMedSearch in Google Scholar
  • 2 Mittal SO, ThatiGanganna S, Kuhns B, Strbian D, Sundararajan S. Acute ischemic stroke in pediatric patients. Stroke 2015; 46 (02) e32-e34
    CrossrefPubMedSearch in Google Scholar
  • 3 Mallick AA, Ganesan V, Kirkham FJ. et al. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol 2014; 13 (01) 35-43
    CrossrefPubMedSearch in Google Scholar
  • 4 Beslow LA, Jordan LC. Pediatric stroke: the importance of cerebral arteriopathy and vascular malformations. Childs Nerv Syst 2010; 26 (10) 1263-1273
    CrossrefPubMedSearch in Google Scholar
  • 5 Mallick AA, O'Callaghan FJ. The epidemiology of childhood stroke. Eur J Paediatr Neurol 2010; 14 (03) 197-205
    CrossrefPubMedSearch in Google Scholar
  • 6 Steinlin M. A clinical approach to arterial ischemic childhood stroke: increasing knowledge over the last decade. Neuropediatrics 2012; 43 (01) 1-9
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Jones BP, Ganesan V, Saunders DE, Chong WK. Imaging in childhood arterial ischaemic stroke. Neuroradiology 2010; 52 (06) 577-589
    CrossrefPubMedSearch in Google Scholar
  • 8 Lanthier S, Carmant L, David M, Larbrisseau A, de Veber G. Stroke in children: the coexistence of multiple risk factors predicts poor outcome. Neurology 2000; 54 (02) 371-378
    CrossrefPubMedSearch in Google Scholar
  • 9 Barnes C, Newall F, Furmedge J, Mackay M, Monagle P. Arterial ischaemic stroke in children. J Paediatr Child Health 2004; 40 (07) 384-387
    CrossrefPubMedSearch in Google Scholar
  • 10 Fullerton HJ, Wu YW, Zhao S, Johnston SC. Risk of stroke in children: ethnic and gender disparities. Neurology 2003; 61 (02) 189-194
    CrossrefPubMedSearch in Google Scholar
  • 11 Ganesan V, Hogan A, Shack N, Gordon A, Isaacs E, Kirkham FJ. Outcome after ischaemic stroke in childhood. Dev Med Child Neurol 2000; 42 (07) 455-461
    CrossrefPubMedSearch in Google Scholar
  • 12 Bulder MMM, Hellmann PM, van Nieuwenhuizen O, Kappelle LJ, Klijn CJ, Braun KP. Measuring outcome after arterial ischemic stroke in childhood with two different instruments. Cerebrovasc Dis 2011; 32 (05) 463-470
    CrossrefPubMedSearch in Google Scholar
  • 13 deVeber GA, MacGregor D, Curtis R, Mayank S. Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol 2000; 15 (05) 316-324
    CrossrefPubMedSearch in Google Scholar
  • 14 Boardman JP, Ganesan V, Rutherford MA, Saunders DE, Mercuri E, Cowan F. Magnetic resonance image correlates of hemiparesis after neonatal and childhood middle cerebral artery stroke. Pediatrics 2005; 115 (02) 321-326
    CrossrefPubMedSearch in Google Scholar
  • 15 Mercuri E, Barnett A, Rutherford M. et al. Neonatal cerebral infarction and neuromotor outcome at school age. Pediatrics 2004; 113 (1 Pt 1): 95-100
    CrossrefPubMedSearch in Google Scholar
  • 16 Zimmer JA, Garg BP, Williams LS, Golomb MR. Age-related variation in presenting signs of childhood arterial ischemic stroke. Pediatr Neurol 2007; 37 (03) 171-175
    CrossrefPubMedSearch in Google Scholar
  • 17 Perkins E, Stephens J, Xiang H, Lo W. The cost of pediatric stroke acute care in the United States. Stroke 2009; 40 (08) 2820-2827
    CrossrefPubMedSearch in Google Scholar
  • 18 Cooper A. Motor Outcomes and Impact on Activities of Daily Living, Following Pediatric Arterial Stroke [Ph.D. dissertation]. Melbourne: The University of Melbourne; 2017
    Search in Google Scholar
  • 19 Cooper AN, Anderson V, Hearps S. et al. Trajectories of motor recovery in the first year after pediatric arterial ischemic stroke. Pediatrics 2017; 140 (02) x
    CrossrefPubMedSearch in Google Scholar
  • 20 Christerson S, Strömberg B. Stroke in Swedish children II: long-term outcome. Acta Paediatr 2010; 99 (11) 1650-1656
    CrossrefPubMedSearch in Google Scholar
  • 21 Amlie-Lefond C, Bernard TJ, Sébire G. et al; International Pediatric Stroke Study Group. Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study. Circulation 2009; 119 (10) 1417-1423
    CrossrefPubMedSearch in Google Scholar
  • 22 Mackay MT, Wiznitzer M, Benedict SL, Lee KJ, Deveber GA, Ganesan V. International Pediatric Stroke Study Group. Arterial ischemic stroke risk factors: the International Pediatric Stroke Study. Ann Neurol 2011; 69 (01) 130-140
    CrossrefPubMedSearch in Google Scholar
  • 23 Kitchen L, Westmacott R, Friefeld S. et al. The pediatric stroke outcome measure: a validation and reliability study. Stroke 2012; 43 (06) 1602-1608
    CrossrefPubMedSearch in Google Scholar
  • 24 Vázquez López M, de Castro de Castro P, Barredo Valderrama E. et al. Outcome of arterial ischemic stroke in children with heart disease. Eur J Paediatr Neurol 2017; 21 (05) 730-737
    CrossrefPubMedSearch in Google Scholar
  • 25 Mallick AA, Ganesan V. Arterial ischemic stroke in children--recent advances. Indian J Pediatr 2008; 75 (11) 1149-1157
    CrossrefPubMedSearch in Google Scholar
  • 26 Guzzetta A, Pizzardi A, Belmonti V. et al. Hand movements at 3 months predict later hemiplegia in term infants with neonatal cerebral infarction. Dev Med Child Neurol 2010; 52 (08) 767-772
    CrossrefPubMedSearch in Google Scholar
  • 27 Golomb MR, deVeber GA, MacGregor DL. et al. Independent walking after neonatal arterial ischemic stroke and sinovenous thrombosis. J Child Neurol 2003; 18 (08) 530-536
    CrossrefPubMedSearch in Google Scholar
  • 28 Ghotra SK, Johnson JA, Qiu W, Newton A, Rasmussen C, Yager JY. Age at stroke onset influences the clinical outcome and health-related quality of life in pediatric ischemic stroke survivors journal. Dev Med Child Neurol 2015; 57 (11) 1027-1134
    CrossrefPubMedSearch in Google Scholar
  • 29 Husson B, Hertz-Pannier L, Renaud C. et al; AVCnn Group. Motor outcomes after neonatal arterial ischemic stroke related to early MRI data in a prospective study. [Erratum appears in Pediatrics 2010;126(5):1053] Pediatrics 2010; 126 (04) 912-918
    CrossrefPubMedSearch in Google Scholar
  • 30 De Vries LS, Groenendaal F, van Haastert IC, Eken P, Rademaker KJ, Meiners LC. Asymmetrical myelination of the posterior limb of the internal capsule in infants with periventricular haemorrhagic infarction: an early predictor of hemiplegia. Neuropediatrics 1999; 30 (06) 314-319
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Dinomais M, Hertz-Pannier L, Groeschel S. et al; AVCnn Study Group. Long term motor function after neonatal stroke: lesion localization above all. Hum Brain Mapp 2015; 36 (12) 4793-4807
    CrossrefPubMedSearch in Google Scholar
  • 32 Staudt M, Niemann G, Grodd W, Krägeloh-Mann I. The pyramidal tract in congenital hemiparesis: relationship between morphology and function in periventricular lesions. Neuropediatrics 2000; 31 (05) 257-264
    Thieme ConnectPubMedSearch in Google Scholar
  • 33 Ganesan V, Ng V, Chong WK, Kirkham FJ, Connelly A. Lesion volume, lesion location, and outcome after middle cerebral artery territory stroke. Arch Dis Child 1999; 81 (04) 295-300
    CrossrefPubMedSearch in Google Scholar
  • 34 Mercuri E, Rutherford M, Cowan F. et al. Early prognostic indicators of outcome in infants with neonatal cerebral infarction: a clinical, electroencephalogram, and magnetic resonance imaging study. Pediatrics 1999; 103 (01) 39-46
    CrossrefPubMedSearch in Google Scholar
  • 35 Cooper AN, Anderson V, Hearps S, et al. The Pediatric Stroke Outcome Measure A predictor of outcome following arterial ischemic stroke. Neurology 2018; 90: e365-e372
    CrossrefPubMedSearch in Google Scholar
  • 36 Mallick AA, Ganesan V, Kirkham FJ. et al. Outcome and recurrence 1 year after pediatric arterial ischemic stroke in a population-based cohort. Ann Neurol 2016; 79 (05) 784-793
    CrossrefPubMedSearch in Google Scholar
  • 37 Steinlin M, Pfister I, Pavlovic J. et al; Swiss Societies of Paediatric Neurology and Neonatology. The first three years of the Swiss Neuropaediatric Stroke Registry (SNPSR): a population-based study of incidence, symptoms and risk factors. Neuropediatrics 2005; 36 (02) 90-97
    Thieme ConnectPubMedSearch in Google Scholar
  • 38 Westmacott R, MacGregor D, Askalan R, deVeber G. Late emergence of cognitive deficits after unilateral neonatal stroke. Stroke 2009; 40 (06) 2012-2019
    CrossrefPubMedSearch in Google Scholar
  • 39 Kim CT, Han J, Kim H. Pediatric stroke recovery: a descriptive analysis. Arch Phys Med Rehabil 2009; 90 (04) 657-662
    CrossrefPubMedSearch in Google Scholar
  • 40 Kolb B, Gibb R. Brain plasticity and recovery from early cortical injury. Dev Psychobiol 2007; 49 (02) 107-118
    CrossrefPubMedSearch in Google Scholar
  • 41 Anderson V, Spencer-Smith M, Leventer R. et al. Childhood brain insult: can age at insult help us predict outcome?. Brain 2009; 132 (Pt 1): 45-56
    CrossrefPubMedSearch in Google Scholar
  • 42 Chapman SB, Max JE, Gamino JF, McGlothlin JH, Cliff SN. Discourse plasticity in children after stroke: age at injury and lesion effects. Pediatr Neurol 2003; 29 (01) 34-41
    CrossrefPubMedSearch in Google Scholar
  • 43 Max JE, Bruce M, Keatley E, Delis D. Pediatric stroke: plasticity, vulnerability, and age of lesion onset. J Neuropsychiatry Clin Neurosci 2010; 22 (01) 30-39
    CrossrefPubMedSearch in Google Scholar
  • 44 Anderson V, Spencer-Smith M, Wood A. Do children really recover better? Neurobehavioural plasticity after early brain insult. Brain 2011; 134 (Pt 8): 2197-2221
    CrossrefPubMedSearch in Google Scholar
  • 45 Kolb B. Synaptic plasticity and the organization of behaviour after early and late brain injury. Can J Exp Psychol 1999; 53 (01) 62-76
    CrossrefPubMedSearch in Google Scholar
  • 46 Kolb B, Pellis S, Robinson TE. Plasticity and functions of the orbital frontal cortex. Brain Cogn 2004; 55 (01) 104-115
    CrossrefPubMedSearch in Google Scholar