Last modified: 2018-09-09
Abstract
Paediatric stroke is rare but does occur. We have managed childhood stroke- piggy-backing on an existing robust adult stroke program in our hospital.
Methods: We undertook retrospective study of children presenting with acute stroke between 2011 – June 2018.
Results: 45 patients with stroke (15 females- 1 recurrence / 29 males; age 15 days - 18 years) presented within 0-8 days. Presenting symptoms: focal neurological deficits, headaches and altered sensorium. Delay in presentation was the norm!
I. Arterial ischemic strokes: 30 (MCA territory: 25; multiple arterial territories: 4; MRI contraindicated:1 )
- Congenital heart disease: 7
- Traumatic dissection: 4
- Moya moya: 3
- Transient cerebral arteriopathy: 2
- Infective endocarditis: 2
- Leptospirosis vasculitis: 1
- Aortoarteritis: 1
- Primary CNS angitis: 1.
- No etiology: 9 (3 not fully investigated)
4 were thrombolysed (NIHSS 8-12) with full recovery/ no adverse events.
A 3 year old girl - mechanical thrombectomy done–NIHSS improved 14 to 2.
II. Transient ischemic attacks: 8 (3 multiple TIAs)
- Moya moya disease: 4
- HANDL: 1
- Autoimmune vasculitis: 1
III. Hemorrhagic strokes: 3
- Warfarin coagulopathy: 1
- Aneurysmal rupture:1: neurointerventional embolization.
IV. Cerebral venous sinus thrombosis: 3
- Cyanotic congenital heart disease/ dehydration: 1
- TB meningitis: 1
- MTHFR homozygous mutation: 1
All were anticoagulated with radiological and clinical reversal.
V. Stroke mimics: 2: extensively investigated: Negative motor focal seizures
Conclusion: This series reflects challenges in paediatric stroke: delayed presentation; delayed diagnosis; validity of offering and lost opportunities in treating acute paediatric strokes; dilemmas of long term anticoagulation and yet excellent outcomes in those treated acutely.