title: Cardioembolic stroke in children: a clinical presentation and outcome study.
abstract: BACKGROUND
  Cardiac disease is a common cause of ischemic stroke in children. Limited information is available about its incidence and long-term outcome.
  
  
  METHODS
  We undertook a retrospective study of children (age 0-17 years) with cardioembolic arterial ischemic stroke, occurring between 1992 and December 2007. Study subjects were observed at the Winnipeg Children's Hospital and identified using multiple databases and disease code searches.
  
  
  RESULTS
  We identified 84 children with arterial ischemic stroke, 17 (20%) of which were cardioembolic stroke (15 non-neonates; 10 females; mean age 4.6 years). The crude annual incidence rate for cardioembolic stroke was estimated to be 0.39 and mortality rate of 0.046 per 100,000 person-years. Stroke occurred commonly in children <5 years (65%) and during hospitalization (65%). Initial presenting symptoms were focal deficits 12 (71%), altered consciousness 5 (29%), seizures 5 (29%), and headache 3 (18%). The mean stroke severity measured by Pediatric National Institutes of Health Stroke Scale was 14.5 (range 2-40) at presentation and 3.7 (range 0-9) at discharge, with mean acute recovery from stroke presentation to discharge of 9.94 (0-32). At 2 years, poor outcome was evident in 10 (59%) children: 2 or >2 Pediatric Stroke Outcome Measure score in 6 (35%), death in 2 (12%), and recurrent stroke in 2 (12%). Factors associated with poor outcome included headache (P = 0.048), high Pediatric National Institutes of Health Stroke Scale at presentation (r = 0.57; P = 0.05) and discharge (r = 0.58; P = 0.05), and high Pediatric Stroke Outcome Measure at discharge (r = 0.77; P = 0.0008).
  
  
  CONCLUSIONS
  Our cohort provides hospital-based incidence estimates for children with cardioembolic stroke. Pediatric National Institutes of Health Stroke Scale performed at different time points can be a helpful tool in measuring stroke recovery and needs to be further explored.
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Markus T
authors.initials: MT
authors.lastname: Ziesmann
authors.affiliation: Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Nash
authors.affiliation: Section of Pediatric Neurology, Department of Pediatrics and Child Health, Children's Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Frances A
authors.initials: FA
authors.lastname: Booth
authors.affiliation: Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada; Section of Pediatric Neurology, Department of Pediatrics and Child Health, Children's Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: mrafay@hsc.mb.ca.
authors.forename: Mubeen F
authors.initials: MF
authors.lastname: Rafay
mesh_terms: D000293:Adolescent; D020520:Brain Infarction / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D020766:Intracranial Embolism / Q000150:complications / Q000209:etiology*; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies
keywords: cardioembolic stroke subtype; cerebrovascular disorders; epidemiology; ischemic