Stroke in children and sickle-cell disease: Baltimore-Washington Cooperative Young Stroke Study.
OBJECTIVE
The Baltimore-Washington Cooperative Young Stroke Study is the largest biracial urban-suburban population-based study to examine the etiology of strokes in children.


METHODS
We identified all children aged 1 to 14 years discharged from all 46 hospitals in central Maryland and Washington, DC with a diagnosis of ischemic stroke and intracerebral hemorrhage in the years 1988 and 1991. Each medical record was reviewed by two neurologists for appropriateness of the diagnosis of stroke and for information on the patient's history, clinical presentation, pertinent investigations, hospital stay, and outcome at time of discharge.


RESULTS
Eighteen children with ischemic infarction and 17 with intracerebral hemorrhage were identified. The most common cause of ischemic stroke was sickle-cell disease (39%), followed by vasculopathic (33%) and indeterminate (28%) causes. Causes of intracerebral hemorrhages were arteriovenous malformation (29%), hematologic (23%), vasculopathy (18%), surgical complication (12%), coagulopathy (6%), and indeterminate (12%). The overall incidence for childhood stroke was 1.29 per 100,000 per year, with ischemic stroke occurring at a rate of 0.58 per 100,000 and intracerebral hemorrhage occurring at a rate of 0.71 per 100,000. The incidence of stroke among children with sickle-cell disease was estimated to be 0.28% or 285 per 100,000 per year.


CONCLUSIONS
Sickle-cell disease plays a disproportionately high role in childhood stroke when a biracial population is surveyed.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
C J
CJ
Earley
S J
SJ
Kittner
B R
BR
Feeser
J
J
Gardner
A
A
Epstein
M A
MA
Wozniak
R
R
Wityk
B J
BJ
Stern
T R
TR
Price
R F
RF
Macko
C
C
Johnson
M A
MA
Sloan
D
D
Buchholz
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications / Q000401:mortality*; D002545:Brain Ischemia / Q000209:etiology / Q000401:mortality; D002533:Cerebral Angiography; D002536:Cerebral Arteries; D002550:Cerebral Veins; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male