Abstract
Background
Cardiac disease is a common cause of ischemic stroke in children. Limited information
is available about its incidence and long-term outcome.
Methods
We undertook a retrospective study of children (age 0-17 years) with cardioembolic
arterial ischemic stroke, occurring between 1992 and December 2007. Study subjects
were observed at the Winnipeg Children's Hospital and identified using multiple databases
and disease code searches.
Results
We identified 84 children with arterial ischemic stroke, 17 (20%) of which were cardioembolic
stroke (15 non-neonates; 10 females; mean age 4.6 years). The crude annual incidence
rate for cardioembolic stroke was estimated to be 0.39 and mortality rate of 0.046
per 100,000 person-years. Stroke occurred commonly in children <5 years (65%) and
during hospitalization (65%). Initial presenting symptoms were focal deficits 12 (71%),
altered consciousness 5 (29%), seizures 5 (29%), and headache 3 (18%). The mean stroke
severity measured by Pediatric National Institutes of Health Stroke Scale was 14.5
(range 2-40) at presentation and 3.7 (range 0-9) at discharge, with mean acute recovery
from stroke presentation to discharge of 9.94 (0-32). At 2 years, poor outcome was
evident in 10 (59%) children: 2 or >2 Pediatric Stroke Outcome Measure score in 6
(35%), death in 2 (12%), and recurrent stroke in 2 (12%). Factors associated with
poor outcome included headache (P = 0.048), high Pediatric National Institutes of Health Stroke Scale at presentation
(r = 0.57; P = 0.05) and discharge (r = 0.58; P = 0.05), and high Pediatric Stroke Outcome Measure at discharge (r = 0.77; P = 0.0008).
Conclusion
Our cohort provides hospital-based incidence estimates for children with cardioembolic
stroke. Pediatric National Institutes of Health Stroke Scale performed at different
time points can be a helpful tool in measuring stroke recovery and needs to be further
explored.
Keywords
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Article info
Publication history
Published online: June 26, 2014
Accepted:
June 18,
2014
Received:
October 21,
2013
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
