Paediatric arterial ischaemic stroke: functional outcome and risk factors

Dev Med Child Neurol. 2010 Apr;52(4):394-9. doi: 10.1111/j.1469-8749.2009.03580.x. Epub 2010 Jan 18.


Aim: To study functional outcome in children aged 1 month to 18 years after paediatric arterial ischaemic stroke (PAIS) and to identify risk factors influencing their quality of life.

Method: In a consecutive series of 76 children (35 males 41 females, median age at diagnosis 2y 6mo, range 1mo-17y 2mo; median length of follow-up 2y 4mo, range [7mo-10y 6mo]) with PAIS diagnosed at the Erasmus Medical Centre Sophia Children's Hospital between 1997 and 2006, we collected clinical, biochemical, and radiological data prospectively. In 66 children surviving at least 1 year after PAIS, functional outcome could be evaluated with the World Health Organization's International Classification of Impairments, Disabilities and Handicaps.

Results: Significant risk factors at presentation for a poor neurological outcome were young age, infarction in the right middle cerebral artery territory, and fever at presentation. Fifty-four % of children had severe neurological impairments at 12 months after PAIS, and at last follow-up more than half needed remedial teaching, special education, or institutionalization. Health-related quality of life (HRQOL) questionnaires showed a significantly lower HRQOL in all age groups. Children with a longer follow-up had a lower HRQOL in the cognitive functioning domain.

Interpretation: Our study shows significant morbidity and mortality and a reduced HRQOL after PAIS depending on age, fever at presentation, and infarction in the right middle cerebral artery territory.

MeSH terms

  • Adolescent
  • Arterial Occlusive Diseases / complications*
  • Child
  • Child, Preschool
  • Disability Evaluation
  • Female
  • Follow-Up Studies
  • Functional Laterality
  • Humans
  • Infant
  • Magnetic Resonance Imaging / methods
  • Male
  • Pediatrics*
  • Quality of Life*
  • Regression Analysis
  • Retrospective Studies
  • Risk Factors
  • Statistics, Nonparametric
  • Stroke / etiology*
  • Stroke / psychology*
  • Surveys and Questionnaires
  • Tomography Scanners, X-Ray Computed
  • Treatment Outcome