Cardioembolic Stroke in Children: A Clinical Presentation and Outcome Study

• 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
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2014.06.013

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.