Çocukluk Çağı Arterial İskemik İnmeleri Ve Sinövenöz Trombozlarında İlişkili Faktörler, Etiyolojinin Belirlenmesi ve Nörolojik Sonuçlar

Abstract

Pediatric stroke is rare compared to adults, however causes long term morbidity and mortality. We retrospectively analysed children beyond newborn period, diagnosed with acute stroke and followed up at Hacettepe University İhsan Doğramacı Children’s Hospital between 2002 and 2017. We reviewed demographic features, physical and neurological examination findings risk factors, etiologic factors, neuroradiological findings, and and outcome. We evaluated current outcome in patients who were seen at follow up visit. There were 94 arterial ischemic stroke (AIS) patients and 27 cerebral sinovenous thrombosis (CSVT) patients in our study. Median age of AIS patients was 4 years. 82% of the AIS patients presented with focal neurological deficits, hemiparesis being the most common focal sign. 30% of AIS patients had seizures during the onset of stroke. Cardiac abnormalities (39%) and arteriopathies (33%) were the most common etiologies. AIS mostly involved unilateral and anterior circulation. Basal ganglions were the main sites of acute infarcts. 90% of the AIS patients were administered antithrombotic therapy and no major complications related to therapy was recorded. During follow-up, 59% of the AIS patients had neurological deficits and 15% had epilepsy. 78% of the CSVT patients presented with diffuse neurological signs and symptoms, headache and vomiting were the most common symptoms. 22% of the CSVT patients presented with seizures. Chronic systemic disorders (63%) and infections (43%) were the most common etiologic factors. CSVT was mostly located in superficial venous system; transverse sinus and superior sagittal sinus were the most common locations. 93% of the CSVT patients received antithrombotic therapy and no major complications related to therapy were recorded. During follow-up, 64% of the CSVT patients didn’t have any neurological deficits and 19% had epilepsy. We concluded that pediatric stroke has a wide spectrum of etiology and risk factors. Although rare in childhood, stroke is a neurological disorder with severe outcome. Timely diagnosis of stroke by pediatricians is crucial; which will then lead to identification of underlying etiology, guide the treatment plan and predict the disease course and recurrences.