Background: Stroke is relatively rare in children but has a significant impact on long term morbidity and mortality. There is limited data exists about etiology, clinical manifestation and prognosis of pediatrics stroke.
Objective: To determine etiology, clinical manifestation and prognosis of pediatric stroke. Material and Method: We retrospectively review all hospital medical records and pediatric neurology database of 91 children who were first diagnosed with acute ischemic stroke, cerebral venous sinus thrombosis and hemorrhagic strokeat Pediatric Department, Chiang Mai University Hospital, Chiang Mai, Thailand between January 1, 2009 and December 31, 2018. All children aged between 1 month and 18-year-old.
Results: The median age of onset was 7 years for ischemic stroke group (IS) and 5 years for hemorrhagic stroke group (HS). The male-to-female ratio was 0.8:1. Fifty-eight IS (64%) and 33 (36%) HS were identified. In IS, 51 had arterial ischemic stroke and 7 had CVST. Moyamoya disease/syndrome was the most common cause inIS (18.97%). Coagulopathy was the most common cause in HS (54.55%). More than one third (39%) of children had more than one risk factor associated with stroke and iron deficiency was the most common (23%). The majority clinical presentation was hemiparesis (72.41%) for IS and alteration of consciousness (66.67%) for HS. The mortality rate of childhood stroke was 15.4%. Mortality rate is higher in HS (38.7%) compared with IS (3.58%) with statistic significant. More than one third of children developed epilepsy during the long term follow up (median duration 26 months). Recurrent stroke occurred in 2 children. Conclusion: Moyamoya disease/syndrome and coagulopathy are the most common cause of IS and HS, respectively. Iron deficiency was found as an associated risk factors of childhood IS. Mortality rate in HS is higher than IS. Recurrent rate of childhood stroke is low compared to adult. One third of children in our study developed epilepsy during a long term follow up.
