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Sheetal S, Thomas R, Ahmad S. Left atrial myxoma presenting with recurrent, bilateral thalamic infarction in a child. J Pediatr Neurosci 2022. [DOI: 10.4103/jpn.jpn_313_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hosseini SA, Gharib MH, Mirheidari SB, Ghanbarzade B, Hosseini PS. Acute Ischemic Stroke in a 10-Month-Old Baby Recovered With Aspirin. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1722928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractAcute ischemic stroke is rare in children and often brings enduring and permanent morbidity in pediatric population. While there are numerous recommendations for initial treatment, evidence on effectiveness of different therapies among children is limited. Here, we describe a 10-month-old male child patient who presented with fever, restlessness, seizure and postictal left limb weakness. Examination revealed left hemiplegia and hemiparesthesia. Computed tomography (CT) head showed loss of gray–white matter distinction with diffuse hypodensity in the right temporoparietal lobes and right caudate nucleus. Magnetic resonance imaging (MRI) brain demonstrated diffusion restriction in favor of acute ischemic stroke in the right middle cerebral artery (MCA) territory. Brain MR angiography (MRA) demonstrated complete occlusion of proximal aspect of M1 segment of right MCA. Genetic testing determined a homozygous 4G/4G polymorphism of the PAI-1 gene. Antiplatelet therapy was started after diagnosis and continued for 8 days with antibiotic therapy. Stroke in children and infants is an infrequent condition associated with substantial morbidity and mortality that needs clinicians' care. This case highlights the significance of awareness about stroke in children and emphasizes on further research to compile evidence-based guidelines for acute stroke therapy in children.
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Affiliation(s)
- Seyed A. Hosseini
- Department of Pediatrics, Golestan University of Medical Sciences, Taleghani Hospital of Gorgan, Golestan, Iran
| | - Mohammad H. Gharib
- Department of Radiology, Golestan University of Medical Sciences, Taleghani Hospital of Gorgan, Golestan, Iran
| | - Seyed B. Mirheidari
- Department of Medicine, Golestan University of Medical Sciences, Taleghani Hospital of Gorgan, Golestan, Iran
| | - Bahar Ghanbarzade
- Golestan University of Medical Sciences, Taleghani Hospital of Gorgan, Golestan, Iran
| | - Parnian S. Hosseini
- Department of Medicine, Golestan University of Medical Sciences, Taleghani Hospital of Gorgan, Golestan, Iran
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Sood A, Suthar R, Sahu JK, K Baranwal A, Saini AG, Saini L, Vyas S, Khandelwal N, Sankhyan N. Etiologic Profile of Childhood Stroke from North India: Is It Different from Developed World? J Child Neurol 2021; 36:655-663. [PMID: 33622066 DOI: 10.1177/0883073821991291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the etiology of childhood arterial-ischemic stroke from a developing country and assess short-term neurologic outcome. METHODS Prospective observational study. Consecutive children between the age of >28 days to <12 years, admitted with the diagnosis of arterial-ischemic stroke were enrolled during the study period from January 2017 to December 2018. Short-term neurologic outcome was assessed with Pediatric Cerebral Performance Category (PCPC) scale and Pediatric Stroke Outcome Measure (PSOM). RESULTS We enrolled 76 children with arterial-ischemic stroke, with a median age of 24 months (interquartile range 12-69), and 43 (57%) were boys. The most common risk factor for childhood arterial-ischemic stroke was arteriopathy in 59 (77%), followed by cardiovascular disorder in 12 (16%) children. Among 59 children with arteriopathy, 32 (42%) had infection-associated arteriopathies, 10 (13%) had mineralizing angiopathy, 10 (13%) had moyamoya disease. Pediatric stroke risk factors were classified according to Pediatric Stroke Classification and CASCADE primary classification. Short-term neurologic outcome was assessed at 3 months in 62 (82%) survivors. Among stroke survivors, 33 (61%) had sensory-motor deficits, and 24 (39%) had severe neurologic disability (PCPC ≥ 4). The presence of fever, encephalopathy, low Glasgow coma score at presentation, seizures, and infection-associated arteriopathy predicted severe neurologic disability at follow-up. CONCLUSION The risk factors for pediatric arterial-ischemic stroke are different from developed countries in our cohort. Infection-associated arteriopathies, mineralizing angiopathy, and moyamoya disease are the most common risk factors in our cohort. Two-thirds of pediatric stroke survivors have neurologic disability at short-term follow-up.
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Affiliation(s)
- Abhinandan Sood
- Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra K Sahu
- Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun K Baranwal
- Pediatric Emergency and Intensive Care Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi G Saini
- Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lokesh Saini
- Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Vyas
- Department of Radiodiagnosis, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Meliţ LE, Mărginean CO, Simu I, Bucur G. Acute ischemic stroke in a 7-month-old infant, risk factors, and diagnosis peculiarities: A case report. Medicine (Baltimore) 2019; 98:e17864. [PMID: 31725629 PMCID: PMC6867755 DOI: 10.1097/md.0000000000017864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ischemic stroke is an extremely rare disorder in children. The timely diagnosis is essential for the outcome of these children, but unfortunately, delays in diagnosis occur frequently. PATIENT CONCERNS We report the case of a 7-month-old infant admitted in our clinic for limited movements of the superior and inferior right limbs whose onset was 27 hours before with repeated clonic movements of the right hand associated with the same manifestations in the right oral commissure lasting approximately 10 seconds. DIAGNOSIS The laboratory tests revealed high D-dimers, and positive IgG anti-cardiolipin and anti-beta2 glycoproteins I antibodies, whereas the genetic profile for thrombophilia revealed heterozygote mutation in MTHFR C677T and A1298C genes. Brain imaging established the diagnosis of left frontal ischemic stroke, frontal ischemic stroke, hypoplasia of internal carotid artery, and agenesia of segment M1 of median cerebral artery and segment A1 of left anterior cerebral artery. INTERVENTION We administered low-molecular-weight heparin, antiplatelet therapy along with vasodilators and depletive treatment, wide-spectrum antibiotics, and anticonvulsant therapy. OUTCOME The neurological deficit was greatly improved, especially in the inferior limb after 6 month from the incident of stroke, and all laboratory parameters were within normal limits including the antibodies mentioned above. CONCLUSION Cerebral vascular malformation, excessive weight, and altered lipid profiles contributed to the development of acute ischemic stroke in our patient.
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Affiliation(s)
| | | | - Iunius Simu
- Department of Radiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures
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Javedani PP, Zukowski M. Cerebrovascular Accident in a Pediatric Patient Presenting With Influenza. J Emerg Med 2019; 57:e17-e19. [PMID: 31027989 PMCID: PMC7126056 DOI: 10.1016/j.jemermed.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/02/2019] [Accepted: 03/08/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acute ischemic stroke (AIS) in pediatric populations accounts for more than half of pediatric strokes and is associated with significant morbidity and mortality. Pediatric AIS can present with nonspecific symptoms or symptoms that mimic alternate pathology. CASE REPORT A 4-month-old female presented to the emergency department for fever, decreased oral intake, and "limp" appearance after antibiotic administration. She was febrile, tachypneic, and hypoxic. Her skin was mottled with 3-s capillary refill, her anterior fontanelle was tense, and she had mute Babinski reflex bilaterally but was moving all extremities. The patient was hyponatremic, thrombocytopenic, and tested positive for influenza A. A computed tomography scan of the brain revealed an acute infarction involving the right frontal, parietal, temporal, and occipital lobes in addition to hyperdensities concerning for thrombosed cortical veins. The patient was transferred for specialty evaluation and was discharged 2 weeks later on levetiracetam. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pediatric AIS can present with nonspecific symptoms that mimic alternate pathology. A high level of suspicion is needed so as not to miss the diagnosis of pediatric AIS in the emergency department. A thorough neurologic assessment is warranted, and subtle abnormalities should be investigated further.
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Peterson RK, McDonald KP, Vincent M, Williams TS, Dlamini N, Westmacott R. Characterizing language outcomes following childhood basal ganglia stroke. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:14-25. [PMID: 31006275 DOI: 10.1080/21622965.2019.1590202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The basal ganglia are important for movement and executive function, but its contribution to language is less understood. This study explored language outcomes associated with childhood basal ganglia stroke. A detailed language coding scheme, which examined expressive and receptive language, verbal fluency, narrative discourse, pragmatic/applied language, and academics, was developed from qualitative and quantitative data acquired from neuropsychological testing and reports. Overall intellectual functioning and verbal comprehension was in the average range. Twelve participants had psychological diagnoses, including Learning Disorder. No one had a Language Disorder diagnosis. Among the 18 children who did not receive a diagnosis, many exhibited language issues in the mild to severe range according to our coding scheme. These children had higher-order language difficulties in verbal fluency, narrative, and pragmatic language rather than overt expressive difficulties noted in Diagnostic and Statistical Manual (DSM) diagnostic criteria. There was an association between infarct size and ESL/immersion education, math performance, and presence of a psychological diagnosis. Psychological diagnosis was also associated with literacy skills. The results highlight that language issues following basal ganglia stroke may not be fully captured by standardized neuropsychological tests and psychological diagnoses. Findings reinforce the need to integrate quantitative and qualitative findings when examining language functioning.
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Affiliation(s)
- Rachel K Peterson
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kyla P McDonald
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Megan Vincent
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tricia S Williams
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nomazulu Dlamini
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Westmacott
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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O'Keeffe F, Stark D, Murphy O, Ganesan V, King J, Murphy T. Psychosocial outcome and quality of life following childhood stroke - A systematic review. Dev Neurorehabil 2017. [PMID: 28632465 DOI: 10.1080/17518423.2017.1282052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this paper was to critically review the recent literature on psychosocial and behavioral outcome following childhood stroke, to assess whether quality of life is affected and to investigate the factors related to psychosocial outcome. METHODS Literature searches were conducted and identified 36 relevant papers from the period 1908-2016. RESULTS The systematic review found that many children experience difficulties in a wide range of psychosocial domains. Quality of life can also be significantly reduced. Inconsistent findings regarding the correlates of outcome are likely due to methodological limitations. These issues include small and heterogeneous samples, lack of control groups, and measurement difficulties. CONCLUSIONS This systematic review strongly indicates that childhood stroke can affect a myriad of psychosocial domains and a child's quality of life. Methodological issues, particularly around heterogeneous samples and measures, limit the conclusions that can be drawn regarding the predictors of outcome.
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Affiliation(s)
- Fiadhnait O'Keeffe
- a Research Department of Clinical, Health and Educational Psychology , University College London , London , UK.,b Department of Clinical Psychology , National Rehabilitation Hospital, Dun Laoghaire, Co . Dublin , Ireland
| | - Daniel Stark
- c Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust , London , UK
| | - Orlagh Murphy
- b Department of Clinical Psychology , National Rehabilitation Hospital, Dun Laoghaire, Co . Dublin , Ireland
| | - Vijeya Ganesan
- c Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust , London , UK
| | - John King
- a Research Department of Clinical, Health and Educational Psychology , University College London , London , UK
| | - Tara Murphy
- c Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust , London , UK
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Language Representation Following Left MCA Stroke in Children and Adults: An fMRI Study. Can J Neurol Sci 2017; 44:483-497. [PMID: 28468691 DOI: 10.1017/cjn.2017.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In this case series, functional magnetic resonance imaging was used to examine brain networks that mediate different aspects of language function in 4 young adults (17-22 years) with a history of left middle cerebral artery (MCA) stroke in childhood (40 years of age). Although it is widely believed that altered lateralization patterns are more likely to occur following early brain injuries compared with later brain injuries, the presumed plasticity of the young brain has been challenged in recent years, particularly in the domain of language. METHODS We explored this issue by contrasting the brain activation patterns of individuals with childhood left MCA stroke and adult left MCA stroke while performing two language tasks: verb generation and picture-word matching. Importantly, both groups showed significant recovery of language function, based on standard clinical indicators. RESULTS Controls showed left lateralized activation for both tasks, although much more pronounced for verb generation. Adult stroke patients also showed left lateralization for both tasks, though somewhat weaker than controls. Childhood stroke patients exhibited significantly weaker lateralization than the adult group for verb generation, but there was no significant group difference for picture-word matching. CONCLUSIONS These preliminary findings suggest that successful reorganization of language function is more likely to involve bilateral recruitment following left MCA stroke in childhood than in adulthood. Of importance, although childhood stroke patients had primarily subcortical lesions, there were substantial alterations in cortical activation patterns.
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Kreling GAD, de Almeida NR, dos Santos PJ. Migrainous infarction: a rare and often overlooked diagnosis. Autops Case Rep 2017; 7:61-68. [PMID: 28740841 PMCID: PMC5507571 DOI: 10.4322/acr.2017.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/01/2017] [Indexed: 12/31/2022]
Abstract
Migraine is a neurological entity and a well-known independent risk factor for cerebral infarction, which mostly afflicts the young female population. Researching focal neurological signs in this subset of the population with the diagnosis of a neurological ischemic event should always take into account the migraine as the etiology or as an associated factor. The etiology of central nervous system (CNS) ischemia is considerable. Migraine, although rare, also may be included in this vast etiological range, which is called migrainous infarction. In this setting, the diagnostic criteria required for this diagnosis is extensive. Herein, we present the case of a female adolescent who submitted to the emergency facility complaining of diplopia, dysarthria, and imbalance, which started concomitantly with a migrainous crisis with aura-a challenging clinical case that required extensive research to address all possible differential diagnoses.
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Affiliation(s)
| | | | - Pedro José dos Santos
- University of São Paulo, Hospital Universitário, Radiology Department. São Paulo, SP, Brazil
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Audic F. [Aetiology, symptoms and complications of a paediatric stroke]. SOINS. PEDIATRIE, PUERICULTURE 2017; 38:17-19. [PMID: 28325380 DOI: 10.1016/j.spp.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In children, as in adults, a stroke corresponds to an acute neurological deficit, secondary to an injury to the cerebral parenchyma which may be of haemorrhagic or ischemic origin, or both. The term 'stroke' comprises a number of pathologies which are extremely heterogenous in terms of physiopathology, risk factors, clinical presentation, evolution and treatment.
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Affiliation(s)
- Frédérique Audic
- Service de médecine infantile, unité de neurologie pédiatrique, Hôpital de la Timone, 264 rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Abstract
Despite being as common as brain tumors in children, lack of awareness of pediatric stroke presents unique challenges, both in terms of diagnosis and management. Due to diverse and overlapping risk factors, as well as variable clinical presentations, the diagnosis can be either missed or frequently delayed. Early recognition and treatment of pediatric stroke is however critical in optimizing long-term functional outcomes, reducing morbidity and mortality, and preventing recurrent stroke. Neuroimaging plays a vital role in achieving this goal. The advancements in imaging over the last two decades have allowed for multiple modality options for suspected stroke with more accurate diagnosis, as well as quicker turnaround time in imaging diagnosis, especially at primary stroke centers. However, with the multiple imaging possibilities, referring physicians can be overwhelmed with the best option for each clinical situation and what the literature recommends. Here the authors review the etiology of pediatric stroke in the settings of arterial ischemia, hemorrhage, and cerebral sinovenous thrombosis (CSVT), with emphasis on the best diagnostic tools available, including advanced imaging techniques.
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Affiliation(s)
- Aashim Bhatia
- Department of Diagnostic Radiology, Monroe Carell, Jr. Children's Hospital at Vanderbilt, Nashville, TN, 37232, USA
| | - Sumit Pruthi
- Department of Diagnostic Radiology, Monroe Carell, Jr. Children's Hospital at Vanderbilt, Nashville, TN, 37232, USA.
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Balachandran A, Kalyanshettar S, Patil S, Shegji V. Ischemic Stroke in Confederation with Trivial Head Trauma. Case Rep Pediatr 2016; 2016:2572958. [PMID: 27313936 PMCID: PMC4903141 DOI: 10.1155/2016/2572958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/29/2016] [Accepted: 05/08/2016] [Indexed: 11/18/2022] Open
Abstract
Minor head injuries in children are common, resulting in brain concussion, and these injuries mostly end up without complications. Usually head trauma results in hemorrhagic stroke. Here we present a case of ischemic stroke following a trivial head trauma. A 10-month-old girl presented with posttraumatic right sided hemiparesis with right sided facial palsy. MRI brain revealed an area of acute infarct in the left capsuloganglionic region. The child was initially managed conservatively, as the hematological parameters were normal, and was started on anticoagulant therapy. An improvement in the clinical condition was achieved in 12 hrs of treatment with gain in power and resolution of weakness in 10 days. The specific cause for hemiparesis in the child is not elicited; possibility of genetic and environmental factors can be attributable.
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Affiliation(s)
- Archana Balachandran
- Department of Pediatrics, Shri. B.M. Patil Medical College Hospital and Research Centre, BLDE University, Vijayapur, Karnataka 586103, India
| | - Siddarameshwar Kalyanshettar
- Department of Pediatrics, Shri. B.M. Patil Medical College Hospital and Research Centre, BLDE University, Vijayapur, Karnataka 586103, India
| | - Shankargouda Patil
- Department of Pediatrics, Shri. B.M. Patil Medical College Hospital and Research Centre, BLDE University, Vijayapur, Karnataka 586103, India
| | - Vijaykumar Shegji
- Department of Pediatrics, Shri. B.M. Patil Medical College Hospital and Research Centre, BLDE University, Vijayapur, Karnataka 586103, India
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Masri A, Al-Ammouri I. Clinical presentation, etiology, and outcome of stroke in children: A hospital-based study. Brain Dev 2016; 38:204-8. [PMID: 26341288 DOI: 10.1016/j.braindev.2015.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/05/2015] [Accepted: 08/07/2015] [Indexed: 01/14/2023]
Abstract
AIM To describe clinical presentations, etiologies, and outcomes of stroke in Jordanian children. PATIENTS AND METHODS We retrospectively reviewed the medical records of children diagnosed with ischemic stroke who presented to our clinic from January 2001 to June 2014. Patients with onset of stroke in the neonatal period were excluded. RESULTS Twenty-four children (12 boys and 12 girls, with a male to female ratio of 1:1) were included in this study. The follow-up period ranged from 1 month to 9 years. Age at onset of the first stroke ranged from 1 month to 13 years. The most common initial clinical presentation was hemiparesis (58.3%). A known etiology was identified in 58.3% of patients. The most common etiologies were metabolic disorders, such as mitochondrial encephalopathy lactic acidosis and stroke (MELAS) and homocystinuria (25%), cardiac disorders (17%), and coagulopathy, such as a homozygous mutation in the MTHFR gene and a factor V Leiden mutation (17%). Recurrence of both clinical and silent strokes occurred in 46% of patients, residual motor weakness occurred in 58.3%, and residual epilepsy occurred in 29.2%. CONCLUSION Metabolic disorders, cardiac disorders, and coagulopathy are the causes of strokes in Jordanian children. Our results emphasized the importance of inherited disorders in Jordan.
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Affiliation(s)
- Amira Masri
- Department of Pediatrics, Division of Child Neurology, Faculty of Medicine, The University of Jordan, Jordan.
| | - Iyad Al-Ammouri
- Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine, The University of Jordan, Jordan
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Bhatnagar S, Naware S, Kuber R, Thind S. Pediatric stroke: neurological sequelae in uncorrected tetralogy of fallot. Ann Med Health Sci Res 2013; 3:S27-30. [PMID: 24349842 PMCID: PMC3853601 DOI: 10.4103/2141-9248.121215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pediatric stroke is an uncommon entity. A risk factor is present in almost half of the children at the time of stroke. The most common cause of stroke in children is probably congenital heart disease. Other risk factors include sickle cell disease, infections, and various prothrombotic conditions. We present a case of a 3-year-old male child, who was previously diagnosed with Tetralogy of Fallot and presented with left-sided weakness and one episode of generalized tonic-clonic seizures.
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Affiliation(s)
- S Bhatnagar
- Department of Radio-diagnosis, Padmashree Dr. Dnyandeo Yashwantrao Patil Hospital and Research Centre, Pimpri, Pune, Maharashtra, India
| | - S Naware
- Department of Radio-diagnosis, Padmashree Dr. Dnyandeo Yashwantrao Patil Hospital and Research Centre, Pimpri, Pune, Maharashtra, India
| | - R Kuber
- Department of Radio-diagnosis, Padmashree Dr. Dnyandeo Yashwantrao Patil Hospital and Research Centre, Pimpri, Pune, Maharashtra, India
| | - Ss Thind
- Department of Radio-diagnosis, Padmashree Dr. Dnyandeo Yashwantrao Patil Hospital and Research Centre, Pimpri, Pune, Maharashtra, India
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Tsze DS, Valente JH. Pediatric stroke: a review. Emerg Med Int 2011; 2011:734506. [PMID: 22254140 PMCID: PMC3255104 DOI: 10.1155/2011/734506] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 09/16/2011] [Indexed: 01/07/2023] Open
Abstract
Stroke is relatively rare in children, but can lead to significant morbidity and mortality. Understanding that children with strokes present differently than adults and often present with unique risk factors will optimize outcomes in children. Despite an increased incidence of pediatric stroke, there is often a delay in diagnosis, and cases may still remain under- or misdiagnosed. Clinical presentation will vary based on the child's age, and children will have risk factors for stroke that are less common than in adults. Management strategies in children are extrapolated primarily from adult studies, but with different considerations regarding short-term anticoagulation and guarded recommendations regarding thrombolytics. Although most recommendations for management are extrapolated from adult populations, they still remain useful, in conjunction with pediatric-specific considerations.
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Affiliation(s)
- Daniel S. Tsze
- Department of Pediatrics, Division of Pediatric Emergency Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Jonathan H. Valente
- Department of Emergency Medicine and Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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Abstract
INTRODUCTION Pediatric stroke, while increasingly recognized among practitioners as a clinically significant, albeit infrequent entity, remains challenging from the viewpoint of clinicians and researchers. DISCUSSION Advances in neuroimaging have revealed a higher prevalence of pediatric stroke while also provided a safer method for evaluating the child's nervous system and vasculature. An understanding of pathogenic mechanisms for pediatric stroke requires a division of ages (perinatal and childhood) and a separation of mechanism (ischemic and hemorrhagic). This article presents a review of the current literature with the recommended divisions of age and mechanism. CONCLUSION Guidelines for treatment, though limited, are also discussed.
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Multiple Organ Infarctions Following Disseminated Intravascular Coagulation Precipitated by Sepsis in A Healthy Infant: A Case Report. Kaohsiung J Med Sci 2010; 26:663-8. [DOI: 10.1016/s1607-551x(10)70101-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 04/27/2010] [Indexed: 11/17/2022] Open
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Abstract
OBJECTIVE The purpose of this manuscript is to review the various etiologies and to discuss the therapeutic issues in childhood stroke. METHODS A PubMed search of literature pertaining to childhood stroke was conducted from 1983 to 2008 using specific key search words pertinent to cerebrovascular disorders in childhood. RESULTS The analysis of the multiple causes of childhood stroke including arterial ischemic strokes and cerebral venous thrombosis was presented. Current therapy and outcome data in childhood stroke are also discussed throughout the length of the article. CONCLUSIONS With increasing vigilance among physicians and improved neuroimaging modalities, the diagnosis of childhood stroke is now made earlier, with increasing frequency and greater accuracy. However, larger and well-controlled studies regarding the optimal management of childhood stroke in terms of the use of both antithrombotic drugs and anticoagulation are still needed in addition to longitudinal follow-up studies of children with stroke.
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Affiliation(s)
- Rosario Maria S Riel-Romero
- Louisiana State University Health Sciences Center, School of Medicine in Shreveport, Shreveport, LA 71130, USA.
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Papp J, Dorsey ST. A Preschool-Age Child With First-Time Seizure and Ataxia. J Emerg Med 2009; 36:30-3. [DOI: 10.1016/j.jemermed.2007.02.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 07/18/2006] [Accepted: 11/16/2006] [Indexed: 11/25/2022]
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Dirik E, Yiş U, Dirik MA, Cakmakçi H, Men S. Vertebral artery dissection in a patient with Wildervanck syndrome. Pediatr Neurol 2008; 39:218-20. [PMID: 18725072 DOI: 10.1016/j.pediatrneurol.2008.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 06/04/2008] [Accepted: 06/09/2008] [Indexed: 10/21/2022]
Abstract
Vertebral artery dissection as a cause of stroke is rarely reported in children. The association between vertebral artery dissection and Klippel-Feil syndrome is also very rare. We report on a case of vertebral artery dissection with posterior circulation involvement in a child with Klippel-Feil syndrome after a hard physical-training lesson. She was also diagnosed with Wildervanck syndrome, with additional clinical findings. Vertebral artery dissection should be considered in patients with Klippel-Feil syndrome who present with acute-onset neurologic signs. Movements such as hyperextension with rotation of the neck should be avoided in these cases.
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Affiliation(s)
- Eray Dirik
- Division of Child Neurology, Department of Pediatrics, Dokuz Eylül University School of Medicine, Izmir, Turkey
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Küker W, Gaertner S, Nagele T, Dopfer C, Schoning M, Fiehler J, Rothwell PM, Herrlinger U. Vessel wall contrast enhancement: a diagnostic sign of cerebral vasculitis. Cerebrovasc Dis 2008; 26:23-9. [PMID: 18511868 DOI: 10.1159/000135649] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Accepted: 01/04/2008] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Inflammatory stenoses of cerebral arteries cause stroke in patients with florid vasculitis. However, diagnosis is often difficult even with digital subtraction angiography (DSA) and biopsy. The purpose of this study was to establish the value of contrast-enhanced MRI, proven to be sensitive to extradural arteritis, for the identification of intracranial vessel wall inflammation. PATIENTS AND METHODS Twenty-seven patients with a diagnosis of cerebral vasculitis affecting large brain vessels were retrieved from the files: 8 children (2-10 years, 7 female, 1 male) and 19 adults (16-76 years, 10 female, 9 male). Diagnosis was based on histological or serological proof of vasculitis or on clinical and imaging criteria. All MRI examinations included diffusion-weighted imaging, time-of-flight magnetic resonance angiography (TOF-MRA) and contrast-enhanced scans. MRI scans were assessed for the presence of ischemic brain lesions, arterial stenoses, vessel wall thickening and contrast uptake. RESULTS Ischemic changes of the brain tissue were seen in 24/27 patients and restricted diffusion suggestive of recent ischemia in 17/27; 25/27 patients had uni- or multifocal stenoses of intracranial arteries on TOF-MRA and 5/6 had stenoses on DSA. Vessel wall thickening was identified in 25/27, wall enhancement in 23/27 patients. CONCLUSION Wall thickening and intramural contrast uptake are frequent findings in patients with active cerebral vasculitis affecting large brain arteries. Further prospective studies are required to determine the specificity of this finding.
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Affiliation(s)
- Wilhelm Küker
- Department of Neuroradiology, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Monagle P, Newall F, Barnes C, Savoia H, Campbell J, Wallace T, Crock C. Arterial thromboembolic disease: a single-centre case series study. J Paediatr Child Health 2008; 44:28-32. [PMID: 17803664 DOI: 10.1111/j.1440-1754.2007.01149.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM Paediatric venous thromboembolic disease has been reported with increased frequency during the last decade. In contrast, the pathophysiology of arterial thromboembolic disease in infants and children has not been adequately explored. The aim of this study was to determine the prevalence, aetiology, diagnostic criteria, management and outcome of arterial thromboembolism (TE) in a tertiary paediatric centre. METHODS A prospective, single-centre registry was established at an Australian tertiary paediatric centre in order to address the aim of this study. RESULTS One-hundred-and-two arterial thrombotic events occurred in 98 patients during 48 months. Infants were most likely to have a lower limb arterial TE (n = 22) whilst children were most likely to have a central nervous system arterial TE (n = 26). Surgery was a frequent predisposing factor in both infants and children. Doppler ultrasonography, computerized tomography and magnetic resonance imaging were the most commonly used diagnostic modalities. Unfractionated heparin was the most frequently used treatment in both age groups. At discharge, 25 infants and twelve children had complete resolution of their arterial TE. Direct thrombosis-related mortality was 4% in infants and 9% in children. Duration of follow-up ranged from 1 to 900 days, with thirteen infants and 32 children never achieving complete resolution. Forty-nine percent of post-discharge survivors had significant long term sequelae directly attributable to their arterial TE. CONCLUSION Arterial TE occurred as frequently as venous TE in our tertiary paediatric population. The clinical outcome and long term sequelae of such events are significant.
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Affiliation(s)
- Paul Monagle
- Department of Clinical Haematology, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Tsai MJ, Lin WC, Kuo CH, Chou HF, Yang RC. Acute midbrain infarction in a child with intracranial carotid artery hypoplasia and aberrant cerebral vasculature: a case report. J Child Neurol 2007; 22:465-70. [PMID: 17621531 DOI: 10.1177/0883073807301922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Strokes identified in older children typically present with sudden hemiparesis, frequent association with seizures, and occasional accompaniment of hemisensory signs or visual field defects. In this case of a left cerebral peduncle infarction, initially the patient was not found with evident right-side hemiparesis but with right-side paresthesia and mild worsening of her underlying left-side weakness, including weakness of left facial expression and left ptosis. Her right limbs became gradually weaker in the first 2 days. These bizarre clinical presentations, the mild worsening of the underlying left-side weakness, and the delayed presentation of right-side hemiparesis added to the difficulty of making a diagnosis and of the initial localization. In addition, the magnetic resonance angiography incidentally found an abnormal vessel, which was additional and serpiginous to the right posterior fossa. The right internal carotid artery was markedly smaller than the left one, and a defect was seen around the area of the presumed distal right internal carotid artery. The abnormal cerebral vasculature might be the cause of the unique clinical presentation and might be the contributing factor to the recurrence of her stroke. In conclusion, the authors report a special case of recurrent stroke on the basis of aberrant cerebral vasculature.
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Affiliation(s)
- Ming-Ju Tsai
- Faculty of Medicine, Medical College, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Abstract
The incidence of stroke in the pediatric population is estimated at between 2 and 3 per 100,000. Strokes are divided into ischemic or hemmorhagic categories, depending on whether the primary cause is obstruction or bleeding into the brain. Strokes may present with acute, recurrent, or evolving neurological deficits. There is a long and varied list of causes of stroke in children. The major causes of ischemic stroke are cardiac abnormalities and coagulation disorders. Cerebrovascular malformations account for the majority of hemmorhaghic strokes. The workup is guided by the initial history and imaging studies. Treatment is dependent on the specific risk factors identified, and outcome is dependent on the location and extent of the initial insult.
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Worley G. Pediatric stroke. Air Med J 2006; 25:59-65. [PMID: 16516116 DOI: 10.1016/j.amj.2005.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Gordon Worley
- REACH Air Medical Services, Marysville, California, USA.
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El Belghiti MR, Aniba K, Bouskraoui M, Fadouach S. Accident vasculaire cérébral révélateur d'une cardiomyopathie dilatée primitive chez un nourrisson de 10 mois. Arch Pediatr 2005; 12:1166-7. [PMID: 15908189 DOI: 10.1016/j.arcped.2005.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2005] [Accepted: 04/02/2005] [Indexed: 10/25/2022]
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Abstract
Ischemic strokes in children, although generally rare events, are more prevalent than commonly believed and can adversely affect brain development. Ischemic strokes in children have been associated with various risk factors, including coagulation defects, cardiac anomalies, inborn errors of metabolism, infections, trauma, and even migraine headaches. We present four children with two or more of these risk factors, indicating multifactorial causes of strokes in children. Neuropsychologic testing in two of our cases also underscores cognitive decline as a result of recurrent strokes.
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Affiliation(s)
- Freedom F Perkins
- Division of Pediatric Neurology, Department of Neurology, University of Texas Medical School, Houston, TX 77030, USA
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Abstract
OBJECTIVE To determine the basis for cardiac consultations for pediatric patients in an academic hospital setting. METHODS The activities of the cardiology consultation service were tabulated for 12 months, from July 2001 to June 2002. Patients were identified from 4 sources, ie, a monthly log of patient encounters maintained by the consultation service, encounter forms submitted to the billing office, consultation notes maintained in a central file, and a departmental list of echocardiography studies. Patients who required clearance for noncardiac surgical procedures were generally evaluated in the cardiology clinic and not by the consultation service. Patient data were obtained from consultation and echocardiography reports and from hospital computer-based records for discharge summaries for inpatient admissions, emergency department encounter summaries, and laboratory reports. For each patient, consultations were tabulated as separate encounters if they occurred on different days in the emergency department, during separate admissions, or for different clinical concerns during a single admission. RESULTS A total of 2071 consultations were performed for 1724 patients. The age at the time of consultation was 6.6 +/- 9.3 years (median: 1.2 years; range: 1 day to 60.6 years). A total of 1507 patients (87.4%) had a single consultation; 217 patients (12.6%) had multiple encounters, ranging from 2 to 9, accounting for 564 consultations (27.2%). Clinical concerns included murmurs (18.5%), cardiac function (12.7%), arrhythmias (12.7%), intercurrent illnesses among cardiac patients (11.3%), cyanosis (6.3%), syndromes (5.7%), chest pain (5.2%), syncope/dizziness (4.5%), subacute endocarditis (4.4%), follow-up evaluations of fetal diagnoses (4.3%), Kawasaki disease (3.4%), cor pulmonale (3%), recent cardiac surgery or catheterization (1.6%), cerebrovascular accidents (1.2%), and miscellaneous conditions. Four diagnoses accounted for 91% of murmur evaluations, ie, patent ductus arteriosus, ventricular septal defects, innocent murmurs, and pulmonary branch murmur of infancy. The most common murmur diagnosis in the neonatal intensive care unit was patent ductus arteriosus (68%), in the well-child nursery was ventricular septal defect (64%), and on the medical ward was innocent murmur (62%). The most common basis for evaluation of function was oncologic disease. Among patients evaluated for function, there were 3 new diagnoses of structural congenital heart disease, all involving neonates with aortic arch obstruction. Approximately two-thirds of arrhythmias were supraventricular in origin. The most common arrhythmias requiring treatment were supraventricular tachycardia and atrial flutter/fibrillation, the latter occurring mainly among older patients with structural heart disease. Diagnoses made with fetal echocardiography accounted for 14.3% of newborn consultations and included 83% of patients with cyanotic cardiac disease. Three syndromes accounted for 57% of consultations for this indication, ie, VACTERL association (vertebral anomalies, anal atresia, congenital heart disease, tracheoesophageal fistula, renal abnormality, and limb anomalies), trisomy 21, and infant of diabetic mother. Chest pain and syncope/dizziness were frequently evaluated in the emergency department and, in this setting, accounted for 13 and 10% of all evaluations and 19 and 25% of evaluations for new patients, respectively. For patients evaluated for chest pain, the most common basis was musculoskeletal/costochondritic (42%) or idiopathic (22%). There was a cardiac or pericardial basis in 11% of cases; these patients either had known heart disease associated with this complication or systemic symptoms, abnormal cardiac auscultatory findings, and electrocardiographic features of pericarditis. Syncope/dizziness most commonly had a vasovagal (50.5%) or orthostatic (24.7%) basis. There was a cardiac basis in 5.4% of cases; these patients were more likely to have symptoms associated with exercise. Although endocarditis was a frequent clinical concern (91 patients), only 3 cases were identified, involving 2 patients with structural heart disease and 1 neonate with an indwelling intracardiac catheter. Two other patients had central venous lines, intravascular thrombus, and fungemia. Kawasaki disease was the most common acquired condition leading to consultation. Cor pulmonale was most commonly screened among patients with congenital diaphragmatic hernia, chronic lung disease of prematurity, pneumonitis, reactive airway disease, or cystic fibrosis. Patients with recent cardiac surgery or cardiac catheterization typically had postpericardiotomy syndrome or complications associated with vascular access. Approximately 20% of cases of cerebrovascular accidents had a cardiac basis. CONCLUSIONS Although a variety of conditions were assessed, some were encountered more frequently. Future educational curricula developed for cardiac training of pediatric residents should appropriately emphasize conditions necessitating consultation.
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Affiliation(s)
- Robert L Geggel
- Department of Cardiology, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
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