Cardioembolic Stroke in Children: A Clinical Presentation and Outcome Study

Abstract Background Cardiac disease is a common cause of ischemic stroke in children. Limited information is available about its incidence and long-term outcome. Methods We undertook a retrospective study of children (age 0-17 years) with cardioembolic arterial ischemic stroke, occurring between 199...

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Bibliographic Details
Published in:Pediatric neurology 2014-10, Vol.51 (4), p.494-502
Main Authors: Ziesmann, Markus T., MD, Nash, Monica, RN, Booth, Frances A., MD, Rafay, Mubeen F., MBBS
Format: Article
Language:English
Subjects:
Adolescent
Brain Infarction - epidemiology
Brain Infarction - etiology
Brain Infarction - physiopathology
Brain Infarction - therapy
cardioembolic stroke subtype
cerebrovascular disorders
Child
Child, Preschool
epidemiology
Female
Heart Diseases - complications
Humans
Incidence
Infant
Infant, Newborn
Intracranial Embolism - complications
Intracranial Embolism - etiology
ischemic
Male
Neurology
Outcome Assessment (Health Care)
Pediatrics
Retrospective Studies
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Summary:Abstract Background Cardiac disease is a common cause of ischemic stroke in children. Limited information is available about its incidence and long-term outcome. Methods We undertook a retrospective study of children (age 0-17 years) with cardioembolic arterial ischemic stroke, occurring between 1992 and December 2007. Study subjects were observed at the Winnipeg Children's Hospital and identified using multiple databases and disease code searches. Results We identified 84 children with arterial ischemic stroke, 17 (20%) of which were cardioembolic stroke (15 non-neonates; 10 females; mean age 4.6 years). The crude annual incidence rate for cardioembolic stroke was estimated to be 0.39 and mortality rate of 0.046 per 100,000 person-years. Stroke occurred commonly in children 2 Pediatric Stroke Outcome Measure score in 6 (35%), death in 2 (12%), and recurrent stroke in 2 (12%). Factors associated with poor outcome included headache ( P  = 0.048), high Pediatric National Institutes of Health Stroke Scale at presentation ( r  = 0.57; P  = 0.05) and discharge ( r  = 0.58; P  = 0.05), and high Pediatric Stroke Outcome Measure at discharge ( r  = 0.77; P  = 0.0008). Conclusion Our cohort provides hospital-based incidence estimates for children with cardioembolic stroke. Pediatric National Institutes of Health Stroke Scale performed at different time points can be a helpful tool in measuring stroke recovery and needs to be further explored.
ISSN:0887-8994
1873-5150
DOI:10.1016/j.pediatrneurol.2014.06.013