Factors associated with six-month outcome of pediatric stroke.
BACKGROUND
Pediatric stroke outcome studies are often cross sectional in design. Prospective information regarding the clinical course following diagnosis is lacking, but may inform clinical management beyond the acute period.


OBJECTIVE
To describe the outcome of arterial ischemic stroke in infants, children and adolescents at one-month and six-months post-stroke across health domains, and explore the relationship between lesion characteristics and early outcome with six-month adaptive behavior.


METHODS
A single center prospective longitudinal study at a tertiary level children's hospital. Recruitment was undertaken from December 2007 to January 2012. Participants were children aged birth to 18 years presenting acutely with first diagnosed arterial ischemic stroke. Lesion characteristics on brain imaging were classified. Children were grouped according to age at diagnosis for analysis (neonates vs. those aged >30 days).


RESULTS
In 50 children with a median age of 47 months at diagnosis, sensorimotor impairments were most evident upon neurological examination acutely, especially in the older children. At both one-month and six-months motor functioning was significantly impaired in the older age group but no significant cognitive or language sequelae were identified. Lesion characteristics alone were not associated with six-month adaptive behavior outcomes.


CONCLUSIONS
For patients surviving arterial ischemic stroke, the most significant clinical consequences both acutely and at six-months, are sensorimotor impairments, particularly evident in the older children. In contrast cognitive or language sequelae were not identified. Long-term surveillance is required to describe clinical course and rehabilitation needs, particularly for neonates and infants.
Clinical Sciences Theme, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.|Pediatric Neuroscience Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK.|Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.
Anne L
AL
Gordon
Clinical Sciences Theme, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.|Department of Psychology, Royal Children's Hospital, Melbourne, Vic, Australia.|Department of Pediatrics, University of Melbourne, Melbourne, Vic, Australia.|School of Psychological Science, University of Melbourne, Melbourne, Vic, Australia.
Vicki
V
Anderson
Department of Diagnostic Imaging, Monash Medical Centre, Southern Health, Melbourne, Vic, Australia.|Department of Paediatrics, Monash University, Melbourne, Vic, Australia.
Michael
M
Ditchfield
Clinical Sciences Theme, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.|Department of Pediatrics, University of Melbourne, Melbourne, Vic, Australia.|Department of Medical Imaging, The Royal Children's Hospital, Melbourne, Vic, Australia.
Lee
L
Coleman
Clinical Sciences Theme, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.|Department of Pediatrics, University of Melbourne, Melbourne, Vic, Australia.|Department of Neurology, The Royal Children's Hospital, Melbourne, Vic, Australia.
Mark T
MT
Mackay
Clinical Sciences Theme, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.|Department of Psychology, Royal Children's Hospital, Melbourne, Vic, Australia.
Mardee
M
Greenham
Clinical Sciences Theme, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.|Department of Pediatrics, University of Melbourne, Melbourne, Vic, Australia.|Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Vic, Australia.
Rod W
RW
Hunt
Clinical Sciences Theme, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.|Department of Pediatrics, University of Melbourne, Melbourne, Vic, Australia.|Department of Haematology, The Royal Children's Hospital, Melbourne, Vic, Australia.
Paul
P
Monagle
D000293:Adolescent; D000367:Age Factors; D001921:Brain / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000175:diagnosis*
cerebrovascular disorders; disability evaluation; outcome measurement (health care); prospective studies