Pak. J. of Neurol. Surg. - Vol. 14, No. 1, Jan. – Jun., 2010 -35- ORIGINAL ARTICLE Clinical Features, Etiological Factors, Neurological Imaging and Outcome in Children with Ischemic Stroke

Abstract

Objective was to study etiological factors, clinical features, neuroradiological findings, Outcome in infants and children who present with ischemic stroke.
Study design: It was a descriptive study.
Setting: It was a hospital based study which was conducted in the Children Hospital, Pakistan Institute of Medical Sciences from 1st August 2002 to 30th December 2003.
Method: In this study children were included who presented with weakness, altered sensorium, seizures, or any focal deficit. CT brain was done in all these children. Those having evidence of infarct were studied for clinical features, etiological factors and out come. Those having neurological infection, trauma, brain tumor, and abscess were excluded from the study. For data analysis, SPSS 8 software was used.
Results: Total of studied thirty patients were enrolled in the study. Age range was from two month to twelve years. Male to female ratio was 3.3 to 1. Sixteen (53%) were 6-12 years of age while 12 (40%) were 2-5 years age and only 2 (6.6%) were below one year of age. Etiological factors were identified in 12 (40%) of the patients, out of which cardiac pathology was found in most of the patients i.e. is 10 (33.3%).There were 2 (6.6%) patients having deficiency of protein C and S .No predisposing factor was identified in 18 (60%) patients. Clinical presentation was studied and was found 29 (96.6%) patients presented with hemiperesis. Facial weakness was present in 15 (56%) of children. Seizures were present in 16 (53.3%) of patients, while 11 (13%) were uncon-scious. Thirteen (43%) were febrile on presentation. Seven (23%) were having swallowing problem, 4 (13.3%) were having headache and only 3 (10%) got visual problem. Middle cerebral artery infarct was commonest seen in that is 19 (63.3%) cases. Lanticulo striate artery infarct was found in 5 (16.3%). Anterior cerebral artery infarct was 4 (13.3%) and only 2 (6.6%) were having Posterior cerebral artery infarct. Complications were also studied in these patients. Seizures were present in 18 (60%) of patients. Nine (30%) developed mild to severe chest infection, while 10 (33.3%) later on develop urinary tract infection. Weight loss was observed in 11 (36.6%) patients. Outcome was studied with the help of Glasgow coma outcome scale. Ten (33.3%) patients showed good outcome, moderate disability was present in 14 (46.6%) of patients, and severe disability was present in 4 (13.3%) of patients, 2 (6.6%) patients died.
Conclusion: It was concluded that ischemic stroke is not rare in Pakistani children. Cardiac disease is the most important and preventable predisposing factor for ischemic stroke. Every effort should be made to diagnose and treat the congenital cardiac disease as early as possible. Middle cerebral artery infarct was the most common infarct. Computed tomography of brain was found to be very useful and sensitive investigation for diagnosis of ischemic infarct. If available neuroimaging studies should be performed in suspected stroke children. Mortality is low while morbidity was quite high among the survivors. Since this was a hospital based study and may not represent general pediatric age group, therefore large scale population based studies should be planned for the future.