Ryan J Felling1, Mubeen F Rafay2, Timothy J Bernard3, Jessica L Carpenter4, Nomazulu Dlamini5,6, Sahar M A Hassanein7, Lori C Jordan8, Michael J Noetzel9, Michael J Rivkin10, Kevin A Shapiro11, Mahmoud Slim5,6, Gabrielle deVeber5,6. 1. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 2. Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada. 3. Department of Pediatrics, University of Colorado, Aurora, Colorado, USA. 4. Departments of Pediatrics and Neurology, George Washington University Children's National Medical Center, Washington, District of Columbia, USA. 5. Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada. 6. Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto, Ontario, Canada. 7. Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt. 8. Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 9. Departments of Neurology and Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA. 10. Departments of Neurology, Radiology, and Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. 11. Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
Abstract
OBJECTIVE: To characterize predictors of recovery and outcome following pediatric arterial ischemic stroke, hypothesizing that age influences recovery after stroke. METHODS: We studied children enrolled in the International Pediatric Stroke Study between January 1, 2003 and July 31, 2014 with 2-year follow-up after arterial ischemic stroke. Outcomes were defined at discharge by clinician grading and at 2 years by the Pediatric Stroke Outcome Measure. Demographic, clinical, and radiologic outcome predictors were examined. We defined changes in outcome from discharge to 2 years as recovery (improved outcome), emerging deficit (worse outcome), or no change. RESULTS: Our population consisted of 587 patients, including 174 with neonatal stroke and 413 with childhood stroke, with recurrent stroke in 8.2% of childhood patients. Moderate to severe neurological impairment was present in 9.4% of neonates versus 48.8% of children at discharge compared to 8.0% versus 24.7% after 2 years. Predictors of poor outcome included age between 28 days and 1 year (compared to neonates, odds ratio [OR] = 3.58, p < 0.05), underlying chronic disorder (OR = 2.23, p < 0.05), and involvement of both small and large vascular territories (OR = 2.84, p < 0.05). Recovery patterns differed, with emerging deficits more common in children <1 year of age (p < 0.05). INTERPRETATION: Outcomes after pediatric stroke are generally favorable, but moderate to severe neurological impairments are still common. Age between 28 days and 1 year appears to be a particularly vulnerable period. Understanding the timing and predictors of recovery will allow us to better counsel families and target therapies to improve outcomes after pediatric stroke. ANN NEUROL 2020;87:840-852.
OBJECTIVE: To characterize predictors of recovery and outcome following pediatric arterial ischemic stroke, hypothesizing that age influences recovery after stroke. METHODS: We studied children enrolled in the International Pediatric Stroke Study between January 1, 2003 and July 31, 2014 with 2-year follow-up after arterial ischemic stroke. Outcomes were defined at discharge by clinician grading and at 2 years by the Pediatric Stroke Outcome Measure. Demographic, clinical, and radiologic outcome predictors were examined. We defined changes in outcome from discharge to 2 years as recovery (improved outcome), emerging deficit (worse outcome), or no change. RESULTS: Our population consisted of 587 patients, including 174 with neonatal stroke and 413 with childhood stroke, with recurrent stroke in 8.2% of childhood patients. Moderate to severe neurological impairment was present in 9.4% of neonates versus 48.8% of children at discharge compared to 8.0% versus 24.7% after 2 years. Predictors of poor outcome included age between 28 days and 1 year (compared to neonates, odds ratio [OR] = 3.58, p < 0.05), underlying chronic disorder (OR = 2.23, p < 0.05), and involvement of both small and large vascular territories (OR = 2.84, p < 0.05). Recovery patterns differed, with emerging deficits more common in children <1 year of age (p < 0.05). INTERPRETATION: Outcomes after pediatric stroke are generally favorable, but moderate to severe neurological impairments are still common. Age between 28 days and 1 year appears to be a particularly vulnerable period. Understanding the timing and predictors of recovery will allow us to better counsel families and target therapies to improve outcomes after pediatric stroke. ANN NEUROL 2020;87:840-852.
Authors: Peter B Sporns; Heather J Fullerton; Sarah Lee; Helen Kim; Warren D Lo; Mark T Mackay; Moritz Wildgruber Journal: Nat Rev Dis Primers Date: 2022-02-24 Impact factor: 52.329
Authors: Agnieszka Kosiorek; Mary T Donofrio; David Zurakowski; Justus G Reitz; Lauren Tague; Jonathan Murnick; Roland Axt-Fliedner; Catherine Limperopoulos; Can Yerebakan; Jessica L Carpenter Journal: Pediatr Cardiol Date: 2021-08-17 Impact factor: 1.655
Authors: Katarina Svensson; Anna Walås; Jenny Bolk; Peter Bang; Heléne E K Sundelin Journal: Paediatr Perinat Epidemiol Date: 2022-02-16 Impact factor: 3.103
Authors: Peter B Sporns; Marios-Nikos Psychogios; Ronald Straeter; Uta Hanning; Jens Minnerup; René Chapot; Hans Henkes; Elina Henkes; Astrid Grams; Franziska Dorn; Omid Nikoubashman; Martin Wiesmann; Georg Bier; Anushe Weber; Gabriel Broocks; Jens Fiehler; Alex Brehm; Daniel Kaiser; Umut Yilmaz; Andrea Morotti; Wolfgang Marik; Richard Nolz; Ulf Jensen-Kondering; Michael Braun; Stefan Schob; Oliver Beuing; Friedrich Goetz; Johannes Trenkler; Bernd Turowski; Markus Möhlenbruch; Christina Wendl; Peter Schramm; Patricia L Musolino; Sarah Lee; Marc Schlamann; Alexander Radbruch; André Karch; Nicole Rübsamen; Moritz Wildgruber; André Kemmling Journal: Neurology Date: 2020-11-03 Impact factor: 9.910