Source:Pediatric Neurology
Author(s): Samantha Carey, Jens Wrogemann, Frances A. Booth, Mubeen F. Rafay
BackgroundAnterior and posterior circulation strokes are often different in terms of presentation and recurrence risk, but there are few studies that focused on posterior circulation stroke.MethodsA longitudinal retrospective study of children, birth to 18-years, with posterior circulation ischemic stroke, at the Children's Hospital Winnipeg, from January 1992-December 2012. Clinical and radiological features and outcomes were collected using standardized tools.ResultsOf the 158 children with arterial ischemic stroke, 23(14.5%) children, 21 non-neonates, 11 males, were identified. For posterior circulation ischemic stroke, mean crude incidence of 0.38 and crude mortality rate of 0.11 per 100,000 person-years was estimated. The crude total period prevalence rate for the study period was estimated as 8.1 per 100,000 children. Non-specific symptoms prior to stroke presentation were present in 38% and impaired consciousness in 71%. Identifiable risk factors were present in two thirds: vasculopathy 24%, infection 19%, trauma 14% and congenital heart disease 9.5%. Average Pediatric National Institutes of Health Stroke Scale score at presentation was 11. Poor outcome was noted in 45%. Outcome did not change significantly between 12 and 24 months. Aboriginal ethnicity(p=0.01), high Pediatric National Institutes of Health Stroke Scale score(p=0.001), bilateral infarction (p=0.001) and large caliber artery territory infarction(p=0.02) predicted poor outcome.ConclusionOur hospital based incidence and outcome data provides valuable information to help direct treatment strategies and prognosticate children with posterior circulation ischemic stroke. Our study calls for close observation and early management of children with posterior circulation stroke, in particular with aboriginal ancestry and bilateral and large artery territory infarction.
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