The recurrence risk of ischemic stroke in childhood.
OBJECTIVE
To determine the risk of recurrence of ischemic stroke in children and to evaluate the influence of etiological factors and underlying mechanisms on recurrence rate.


METHODS
Thirty-six children (21 boys and 15 girls) with clinically and radiographically proven ischemic cerebral infarction were prospectively followed up over a period of 1-9 years (median 5 years 5 months). The median age of onset of stroke was 8.4 years (1-16 years). Patients with hemorrhagic stroke, neonatal infarction and sinovenous thrombosis were not included. The patients were analyzed according to the mechanisms and etiology of the initial and recurrent stroke event.


RESULTS
For the initial stroke, cardioembolic (33.3%) and arteriopathic processes (36.1%) were identified as the most probable mechanisms of arterial ischemic stroke. Prothrombotic abnormalities were found in 4 children (11.1%). Underlying pathology in the remaining 7 (19.4%) was not known. Recurrent ischemic infarction was diagnosed in 5 children (13.9%) within 5 days to 18 months (median 6 months) after the first stroke manifestation. In 3 of them stroke recurrence was due to cardiac or transcardiac embolism. Cardiac abnormality prior to the first stroke was detected in 1 child. Clinically silent multiple cerebral infarcts disclosed by MRI preceded the overt stroke episode in 2 patients.


CONCLUSIONS
Congenital and acquired heart diseases were the most common cause of repeated stroke in our study. The risk of recurrence appeared to be fivefold higher in children with cardiac disease irrespective of the coexistence of other risk factors. The risk factors of stroke in children were multiple and overlapping. Consequently, recognition of the major one and its underlying mechanism is crucial for both effective therapeutic approach and the prevention of recurrence.
Brankovic-Sreckovic
Vesna
V
Clinic for Child Neurology and Psychiatry, Medical Faculty, University of Belgrade, Belgrade, Serbia and Montenegro. vladas@infosky.net
Milic-Rasic
Vedrana
V
Jovic
Nebojsa
N
Milic
Natasa
N
Todorovic
Slobodanka
S
D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D002544:Cerebral Infarction / Q000209:etiology; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications; D006331:Heart Diseases / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D015022:Yugoslavia / Q000453:epidemiology