title: Presentation of Acute Childhood Stroke in a Tertiary Pediatric Emergency Department.
abstract: OBJECTIVE
  The aim was to describe clinical presentation, management, and outcomes of stroke in a tertiary emergency department (ED) of a developing country.
  
  
  METHODS
  Retrospective case series of patients aged 1 month to 18 years presenting to an ED with radiological confirmed acute stroke during a 7-year period were studied.
  
  
  RESULTS
  Ninety-five patients were identified. Twenty-five patients were excluded because of incomplete records (8) or not presenting via ED (17). Thirty-four (48.5%) were diagnosed with hemorrhagic stroke (HS), 30 (42.8%) with arterial ischemic stroke (AIS), and 6 (8.5%) with sinus venous thrombosis (SVT). Mean age was 5.3 years, and 55.3% were male. The median time from onset of symptoms to ED presentation was 24 hours (mean, 55 hours; interquartile range [IQR], 14-72) for AIS, 24 hours (mean, 46.9 hours; IQR, 9-48) for HS, and 120 hours (mean,112 hours; IQR, 72-168) for SVT. Congenital cardiac disease was the most common risk factor (9%). For AIS, the most common symptoms were focal numbness 56.6% (95% confidence interval [CI], 37.8%-75.4%), focal weakness 56.6% (95% CI, 37.8%-75.4%), and seizures 50% (95% CI, 31%-68.8%). For HS, the most common symptoms were headache 64.7% (95% CI, 47.7%-81.6%), vomiting 79.4 (95% CI, 65-93.7), and altered mental status 64.7% (95% CI, 47.7-81.6). Computed tomography scan was done in 100% of the patients and magnetic resonance imaging in 54%. Twenty-five (36%) patients were admitted to intensive care unit and required intubation. Long-term deficit was identified in 24 (36%) patients based on medium-term follow-up.
  
  
  CONCLUSIONS
  The spectrum of stroke in a developing country was similar to published series from developed countries in terms of final diagnosis, risk factors, and delay to ED presentation, neuroimaging, and long-term neurodeficits. No tropical diseases were identified as risk factors.
authors.forename: Adriana
authors.initials: A
authors.lastname: Yock-Corrales
authors.affiliation: Cardiology Department, and.
authors.forename: Flory
authors.initials: F
authors.lastname: Varela-Bulgarelli
authors.affiliation: Cardiology Department, and.
authors.forename: Cary
authors.initials: C
authors.lastname: Barboza
authors.forename: Alfonso
authors.initials: A
authors.lastname: Gutierrez-Mata
authors.forename: Mark T
authors.initials: MT
authors.lastname: Mackay
authors.forename: Franz
authors.initials: F
authors.lastname: Babl
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003364:Costa Rica; D003906:Developing Countries; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D062606:Tertiary Care Centers / Q000706:statistics & numerical data