title: Outcome and recurrence 1 year after pediatric arterial ischemic stroke in a population-based cohort.
abstract: OBJECTIVE
  Arterial ischemic stroke (AIS) is an important cause of acquired brain injury in children. Few prospective population-based studies of childhood AIS have been completed. We aimed to investigate the outcome of childhood AIS 12 months after the event in a population-based cohort.
  
  
  METHODS
  Children aged 29 days to < 16 years with radiologically confirmed AIS occurring over a 1-year period residing in southern England (population = 5.99 million children) were eligible for inclusion. Outcome was assessed during a home visit using the Pediatric Stroke Outcome Measure (PSOM). Parental impressions of recovery were assessed using the Pediatric Stroke Recurrence and Recovery Questionnaire. PSOM score was estimated via telephone interview or clinician interview whenever home visit was not possible.
  
  
  RESULTS
  Ninety-six children with AIS were identified. Two children were lost to follow-up. Nine of 94 (10%) children died before the 12-month follow-up. One child had an AIS recurrence. PSOM scores were available for 78 of 85 living children at follow-up. Thirty-nine of 78 (50%) had a good outcome (total PSOM score < 1), and 39 of 78 (50%) had a poor outcome. Seizures at onset of AIS were associated with a poor outcome (odds ratio = 3.5, 95% confidence interval = 1.16-10.6). Twenty-eight of 73 (38%) children were judged by their carers to have fully recovered. Ten of 84 (12%) children had recurrent seizures, and 17 of 84 (20%) reported recurrent headaches.
  
  
  CONCLUSIONS
  AIS carries a significant risk of mortality and long-term neurological deficit. However, the rates of mortality, recurrence, and neurological impairment were markedly lower in this study than previously published figures in the United Kingdom. Ann Neurol 2016;79:784-793.
authors.affiliation: Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Mallick
authors.affiliation: Neurosciences Unit, University College London Institute of Child Health, London.
authors.forename: Vijeya
authors.initials: V
authors.lastname: Ganesan
authors.affiliation: Neurosciences Unit, University College London Institute of Child Health, London.|Department of Child Health, Southampton University Hospitals National Health Service Trust, Southampton.
authors.forename: Fenella J
authors.initials: FJ
authors.lastname: Kirkham
authors.affiliation: Department of Paediatric Neurology, St George's Hospital, London.
authors.forename: Penny
authors.initials: P
authors.lastname: Fallon
authors.affiliation: Department of Paediatric Neurology, King's College Hospital National Health Service Foundation Trust, London.|Department of Paediatric Neurosciences, Evelina Children's Hospital, London.
authors.forename: Tammy
authors.initials: T
authors.lastname: Hedderly
authors.affiliation: Department of Paediatric Neurology, John Radcliffe Hospital, Oxford.
authors.forename: Tony
authors.initials: T
authors.lastname: McShane
authors.affiliation: Department of Paediatric Neurology, Addenbrooke's Hospital, Cambridge.
authors.forename: Alasdair P
authors.initials: AP
authors.lastname: Parker
authors.affiliation: Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham.
authors.forename: Evangeline
authors.initials: E
authors.lastname: Wassmer
authors.affiliation: Department of Paediatric Neurosciences, Evelina Children's Hospital, London.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wraige
authors.affiliation: Neurosciences Unit, University College London Institute of Child Health, London.
authors.forename: Sam
authors.initials: S
authors.lastname: Amin
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol.
authors.forename: Hannah B
authors.initials: HB
authors.lastname: Edwards
authors.affiliation: Population, Policy, and Practice Programme, University College London Institute of Child Health, London.
authors.forename: Mario
authors.initials: M
authors.lastname: Cortina-Borja
authors.affiliation: Neurosciences Unit, University College London Institute of Child Health, London.|School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Finbar J
authors.initials: FJ
authors.lastname: O'Callaghan