Publication:

A study of risk factors and clinical outcome of stroke in children

Background Stroke is a significant cause of neurological morbidity and mortality in children. Early recognition permits timely therapeutic intervention aimed at preventing recurrence and improving long-term outcome. The objective of this study was to determine the risk factors, clinical outcome of stroke in children and to evaluate any association between them.

Methods This was a prospective, observational study, conducted over one and a half year at a tertiary care centre. Children between 1 month to 12 years and diagnosed to have stroke were enrolled. The clinical profile, investigations and outcome of stroke were studied. Data collected was analysed using Pearson chi-square test.

Results Of 55 children enrolled, definite etiology could be determined in 44 (80%) children. The common risk factors identified were vasculitis (30.9%), vasculopathy (23.6%), hypercoagulable states (18.1%), cardiac diseases (12.7%) and bleeding diathesis (7.2%). Focal neurologic deficits (69%), convulsions (58%), altered sensorium (41.8%), fever (45.4%) and aphasia (34.5%) were the chief presenting features. The overall mortality was 30.9% and neurologic deficits were observed in 54.5%. Children with undetermined etiology had a favorable outcome compared to those with definite etiology (p=0.007). Poor outcome was witnessed with vasculitis and cardiac diseases; recurrence was common with Moyamoya disease. Presence of either of altered sensorium (p=0.0005) or convulsions (p=0.046) or visual complaints (p=0.032) or headache (p=0.042) were associated with poor outcome whereas presence of focal neurologic deficits alone predicted a better outcome (p=0.036).

Conclusions The nature of risk factor and the clinical presentation significantly influence the outcome of stroke in children.