Childhood stroke: results of 130 children from a reference center in Central Anatolia, Turkey.
BACKGROUND
Although stroke among children is rare, it can cause significant morbidity and mortality. We aim to share our experience of children with arterial ischemic stroke.


METHODS
The initial symptoms, demographical features, risk factors, neurological examination, neuroradiological findings, and clinical follow-up data of 130 Turkish children seen between 2002 and 2013 were retrospectively analyzed.


RESULTS
Sixty-eight patients were male. Thirty of the children were aged from 1 to 12 months (seven of them died in this period). Focal neurological signs were the most common presentation, and hemiplegia or hemiparesis were the most common focal signs. Underlying risk factors were detected in 103 patients. Infections and congenital heart disease were the most common risk factors. Seven of the nine children with recurrent arterial ischemic strokes had one or more underlying diseases (moyamoya disease in two children along with factor V Leiden mutation, tuberculous meningitis, congenital heart disease, homocystinuria, and hemiconvulsion-hemiplegia-epilepsy syndrome). The arterial ischemic stroke was located in the middle cerebral circulation in 68 (36 left and 32 right) and in the posterior cerebral artery in 41. Eighteen children died. The neurological outcome was assessed in 98 children. Of these children, 66 children have neurological deficits and 52 children have seizures. Stroke in the first year of life is more often fatal. Recurrent stroke is associated with poor prognosis.


CONCLUSIONS
Tuberculous meningitis is still a risk factor for arterial ischemic stroke in Turkey. Arterial ischemic stroke in the first year of life and recurrent arterial ischemic stroke represent poor prognostic features.
Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
Huseyin
H
Per
Division of Pediatric Hematology and Oncology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey. Electronic address: drekremunal@yahoo.com.tr.
Ekrem
E
Unal
Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
Hatice Gamze
HG
Poyrazoglu
Division of Pediatric Hematology and Oncology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
Mehmet Akif
MA
Ozdemir
Division of Interventional Radiology, Department of Radiology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
Halil
H
Donmez
Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
Hakan
H
Gumus
Division of Pediatric Cardiology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
Kazım
K
Uzum
Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
Mehmet
M
Canpolat
Pediatric Intensive Care Unit, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
Basak Nur
BN
Akyildiz
Division of Pediatric Radiology, Department of Radiology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
Abdulhakim
A
Coskun
Department of Neurosurgery, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
Ali
A
Kurtsoy
Division of Pediatric Neurology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
Sefer
S
Kumandas
D000293:Adolescent; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000473:pathology; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D020768:Middle Cerebral Artery / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D062606:Tertiary Care Centers; D014390:Tuberculosis, Meningeal / Q000453:epidemiology; D014421:Turkey / Q000453:epidemiology
arterial ischemic stroke; children; clinical features; neuroradiological findings; prognosis