Cardiac disease is a common cause of ischemic stroke in children. Limited information is available about its incidence and long-term outcome.
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.
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).
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.
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- The recurrence risk of ischemic stroke in childhood.Med Princ Pract. 2004; 13: 153-158
- Arterial ischemic stroke in Canadian children.Ann Neurol. 2006; 60: S114
- Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis.J Child Neurol. 2000; 15: 316-324
- Arterial ischaemic stroke in children. Review of the literature and strategies for future stroke studies.Thromb Haemost. 2004; 92: 697-706
- Stroke in children: the coexistence of multiple risk factors predicts poor outcome.Neurology. 2000; 54: 371-378
- Cerebrovascular disorders in children.Curr Neurol Neurosci Rep. 2004; 4: 129-138
- Arterial ischemic stroke risk factors: the International Pediatric Stroke Study.Ann Neurol. 2011; 69: 130-140
- Outcome after ischaemic stroke in childhood.Dev Med Child Neurol. 2000; 42: 455-461
- Risk factors for arterial ischemic stroke in children.J Child Neurol. 2000; 15: 299-307
- Stroke in newborn infants.Lancet Neurol. 2004; 3: 150-158
- Stroke in childhood: outcome and recurrence risk by mechanism in 59 patients.J Child Neurol. 2000; 15: 290-294
- Stroke recurrence in children with congenital heart disease.Ann Neurol. 2012; 72: 103-111
- Frequency, predictors, and neurologic outcomes of vaso-occlusive strokes associated with cardiac surgery in children.Pediatrics. 2008; 122: 1292-1298
- Antithrombotic treatments, outcomes, and prognostic factors in acute childhood-onset arterial ischaemic stroke: a multicentre, observational, cohort study.Lancet Neurol. 2009; 8: 1120-1127
- International Paediatric Stroke Study: stroke associated with cardiac disorders.Int J Stroke. 2013; 8: 39-44
- Measurements of acute cerebral infarction: a clinical examination scale.Stroke. 1989; 20: 864-870
- Concurrent validity and reliability of retrospective scoring of the Pediatric National Institutes of Health Stroke Scale.Stroke. 2012; 43: 341-345
- Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study.Stroke. 2011; 42: 613-617
- The pediatric stroke outcome measure: a validation and reliability study.Stroke. 2012; 43: 1602-1608
Statistics Canada 2006 Census: Population by selected ethnic origins, by province and territory (2006 Census) (Manitoba). 12-23-2011. (available on-line at http://www.statcan.gc.ca/).
- Risk factors for arterial ischemic stroke in childhood.CNS Spectr. 2004; 9: 451-464
- Investigation of risk factors in children with arterial ischemic stroke.Ann Neurol. 2003; 53: 167-173
- Male predominance in childhood ischemic stroke: findings from the international pediatric stroke study.Stroke. 2009; 40: 52-57
- Risk of stroke in children: ethnic and gender disparities.Neurology. 2003; 61: 189-194
- Cardiovascular risk factors in Australian indigenous and non-indigenous children: a population-based study.J Paediatr Child Health. 2009; 45: 20-27
Published online: June 26, 2014
Accepted: June 18, 2014
Received: October 21, 2013
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.