title: Childhood ischemic stroke in a nonurban population.
abstract: A 10-year, retrospective review of the etiology, outcome, and complications of ischemic stroke in children from a nonurban population was conducted. Twenty-seven children were identified (14 boys, 13 girls), ages 1.25 to 17 years (mean 7.7 years). Etiologies included undetermined (22%), arterial dissection (19%), coagulopathy (15%), embolism (15%), moyamoya disease (11%), sickle cell disease (11%), isolated angiitis of the central nervous system or vasculitis (11%), or other known source (11%; two fibromuscular dysplasia, one L-asparaginase). More than one risk factor was present in five children. Seventeen (65%) children were anticoagulated, with no adverse events occurring. Nine children were anticoagulated initially with low-molecular-weight heparin. Other treatments included corticosteroids; physical, occupational, and speech therapy; and anticonvulsants for concomitant seizures. Follow-up ranged from 3 to 60 months (mean 17 months) and was as follows: 6 (22%) were normal, 9 (33%) had mild impairment, and 12 (44%) had moderate to severe deficits. There were no deaths. Neurologic complications included seizure (two), behavioral problems (two), and hemorrhagic conversion (one). In this population, the outcome from ischemic stroke was similar to that of other studies, with the majority of children demonstrating persistent neurologic deficits. Etiology could be determined for the majority of patients, with 19% having more than one risk factor.
authors.affiliation: Division of Pediatric Neurology, Penn State Children's Hospital, The Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Bowen
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Burak
authors.forename: Todd F
authors.initials: TF
authors.lastname: Barron
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications; D000970:Antineoplastic Agents / Q000009:adverse effects; D001215:Asparaginase / Q000009:adverse effects; D001778:Blood Coagulation Disorders / Q000150:complications; D002545:Brain Ischemia / Q000209:etiology* / Q000628:therapy; D002340:Carotid Artery Diseases / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications; D006801:Humans; D007223:Infant; D020766:Intracranial Embolism / Q000150:complications; D008297:Male; D012307:Risk Factors; D012424:Rural Population; D020521:Stroke / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome; D020293:Vasculitis, Central Nervous System / Q000150:complications
chemical_list: D000970:Antineoplastic Agents; D001215:Asparaginase