title: Basilar artery strokes in children: good outcomes with conservative medical treatment.
abstract: OBJECTIVE
  To describe outcomes and outcome predictors in childhood basilar artery stroke (BAS).
  
  
  METHODS
  We prospectively enrolled children with BAS with or without basilar artery occlusion (BAO) in the Toronto Children's Stroke Registry from 1992 to 2009. We assessed presenting features and outcomes including Pediatric Stroke Outcome Measure scores.
  
  
  RESULTS
  Among 578 children with acute arterial ischemic stroke, 27 had BAS (4.6% including neonates, 6% excluding neonates). Twenty-four (14 males, 10 females) children met study criteria (mean age at stroke was 8 y 10 mo; range 0-17 y). Eleven children had BAO. Aspirin or anticoagulation was given to 15 children. None received tissue plasminogen activator or endovascular treatments. At mean follow-up (3 y 2 mo, range 1 mo-11 y 8 mo), 12 had a 'good outcome' (seven normal, five insignificant deficit) and 12 had 'poor outcome' (10 moderate or severe deficit, two acute deaths). Larger infarct size (≥50% of axial brainstem diameter) independently predicted poor outcome (p=0.02; odds ratio 21.2, 95% confidence interval 1.6-274.9) but not BAO, altered level of consciousness, or age.
  
  
  CONCLUSIONS
  Compared with adults, in childhood BAS death is rare and survivors frequently have good outcomes. Aggressive endovascular interventions may not be justifiable in this population.
authors: Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada. anamarissa.lagman@sickkids.ca
authors: Ana Marissa
authors: AM
authors: Lagman-Bartolome
authors: Ann-Marie
authors: AM
authors: Pontigon
authors: Mahendranath
authors: M
authors: Moharir
authors: Daune L
authors: DL
authors: MacGregor
authors: Rand
authors: R
authors: Askalan
authors: Ivanna
authors: I
authors: Yau
authors: Gabrielle
authors: G
authors: Deveber
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012016:Reference Values; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020521:Stroke / Q000209:etiology* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014715:Vertebrobasilar Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D000925:Anticoagulants; D001241:Aspirin