Paediatric arterial ischaemic stroke: functional outcome and risk factors.
OBJECTIVE
To study functional outcome in children aged 1 month to 18 years after paediatric arterial ischaemic stroke (PAIS) and to identify risk factors influencing their quality of life.


METHODS
In a consecutive series of 76 children (35 males 41 females, median age at diagnosis 2y 6mo, range 1mo-17y 2mo; median length of follow-up 2y 4mo, range [7mo-10y 6mo]) with PAIS diagnosed at the Erasmus Medical Centre Sophia Children's Hospital between 1997 and 2006, we collected clinical, biochemical, and radiological data prospectively. In 66 children surviving at least 1 year after PAIS, functional outcome could be evaluated with the World Health Organization's International Classification of Impairments, Disabilities and Handicaps.


RESULTS
Significant risk factors at presentation for a poor neurological outcome were young age, infarction in the right middle cerebral artery territory, and fever at presentation. Fifty-four % of children had severe neurological impairments at 12 months after PAIS, and at last follow-up more than half needed remedial teaching, special education, or institutionalization. Health-related quality of life (HRQOL) questionnaires showed a significantly lower HRQOL in all age groups. Children with a longer follow-up had a lower HRQOL in the cognitive functioning domain.


CONCLUSIONS
Our study shows significant morbidity and mortality and a reduced HRQOL after PAIS depending on age, fever at presentation, and infarction in the right middle cerebral artery territory.
Cnossen
Marjon H
MH
Department of Paediatric Oncology and Haematology, Erasmus Medical Centre/Sophia Children's Hospital, Rotterdam, the Netherlands.
Aarsen
Femke K
FK
Akker
Sandra Lj van Den
SLj
Danen
Renee
R
Appel
Inge M
IM
Steyerberg
Ewout W
EW
Catsman-Berrevoets
Coriene E
CE
D000293:Adolescent; D001157:Arterial Occlusive Diseases / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010372:Pediatrics; D011788:Quality of Life; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D020521:Stroke / Q000209:etiology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome