Arterial ischemic stroke in infants, children, and adolescents: results of a Germany-wide surveillance study 2015-2017

Abstract

Objective: Childhood arterial ischaemic stroke (AIS) is rare, but causes significant morbidity and mortality. We aimed to investigate incidence, age-dependent clinical presentation, and risk factors and to discuss the medical care situation in Germany.

Methods: This prospective epidemiological study was conducted via ESPED (Erhebungseinheit für Seltene Pädiatrische Erkrankungen in Deutschland), a hospital-based German nation-wide surveillance unit for rare pediatric diseases. Children aged 28 days-18 years with first AIS between January 2015 and December 2017 were included.

Results: In the 3-year period, 164 children were reported. Incidence showed peaks in infants, children < 2 years of age, and adolescents (12-18 years), with a significant male predominance observed in adolescents only. Independent of age, most children (91%) presented with focal symptoms, particularly with acute hemiparesis. The occurrence of seizures in infants (57%) and more nonspecific symptoms in school-children and adolescents (54%) is considered noteworthy. Prothrombotic states (34%), cardiac disorders (29%), and arteriopathies (19%) were the most frequently identified risk factors. The majority of children (72/131, thus 55%) were discharged home after acute care phase. At time of discharge, most common neurological symptoms were hemiparesis (42%), facial palsy (15%), and speech disturbance (12%).

Conclusion: This study provides population-based data of childhood AIS which may be useful for further research. The improvement of acute stroke management is needed for children, but also the standardization of post-stroke care in the outpatient setting has to be structured. Considering the higher stroke incidence in (male) adolescents, it is advisable to combine research activities in adolescents and young adults.

Keywords: Childhood stroke; Pediatric stroke; Risk factors; Symptoms.