Bin Jiang1, Nancy K Hills2, Rob Forsyth3, Lori C Jordan4, Mahmoud Slim5, Steven G Pavlakis6, Neil Freidman7, Nomazulu Dlamini5, Osman Farooq8, Ying Li1, Guangming Zhu1, Heather Fullerton2, Max Wintermark1, Warren D Lo9,10. 1. Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA (B.J., Y.L., G.Z., M.W.). 2. Department of Neurology, University of California, San Francisco (N.K.H., H.F.). 3. Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kindgom (R.F.). 4. Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN (L.C.J.). 5. Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada (M.S., N.D.). 6. Department of Neurology, SUNY Downstate, Brooklyn, NY (S.G.P.). 7. Center for Pediatric Neurosciences, Cleveland Clinic, OH (N.F.). 8. Department of Neurology, Jacobs School of Medicine, University at Buffalo, NY (O.F.). 9. Department of Neurology and Pediatrics, The Ohio State University, Columbus (W.D.L.). 10. Departments of Pediatrics and Neurology, Nationwide Children's Hospital, Columbus, OH (W.D.L.).
Abstract
BACKGROUND AND PURPOSE: To assess whether initial imaging characteristics independently predict 1-year neurological outcomes in childhood arterial ischemic stroke patients. METHODS: We used prospectively collected demographic and clinical data, imaging data, and 1-year outcomes from the VIPS study (Vascular Effects of Infection in Pediatric Stroke). In 288 patients with first-time stroke, we measured infarct volume and location on the acute magnetic resonance imaging studies and hemorrhagic transformation on brain imaging studies during the acute presentation. Neurological outcome was assessed with the Pediatric Stroke Outcome Measure. We used univariate and multivariable ordinal logistic regression models to test the association between imaging characteristics and outcome. RESULTS: Univariate analysis demonstrated that infarcts involving uncinate fasciculus, angular gyrus, insular cortex, or that extended from cortex to the subcortical nuclei were significantly associated with poorer outcomes with odds ratios ranging from 1.95 to 3.95. All locations except the insular cortex remained significant predictors of poor outcome on multivariable analysis. When infarct volume was added to the model, the locations did not remain significant. Larger infarct volumes and younger age at stroke onset were significantly associated with poorer outcome, but the strength of the relationships was weak. Hemorrhagic transformation did not predict outcome. CONCLUSIONS: In the largest pediatric arterial ischemic stroke cohort collected to date, we showed that larger infarct volume and younger age at stroke were associated with poorer outcomes. We made the novel observation that the strength of these associations was modest and limits the ability to use these characteristics to predict outcome in children. Infarcts affecting specific locations were significantly associated with poorer outcomes in univariate and multivariable analyses but lost significance when adjusted for infarct volume. Our findings suggest that infarcts that disrupt critical networks have a disproportionate impact upon outcome after childhood arterial ischemic stroke.
BACKGROUND AND PURPOSE: To assess whether initial imaging characteristics independently predict 1-year neurological outcomes in childhood arterial ischemic stroke patients. METHODS: We used prospectively collected demographic and clinical data, imaging data, and 1-year outcomes from the VIPS study (Vascular Effects of Infection in Pediatric Stroke). In 288 patients with first-time stroke, we measured infarct volume and location on the acute magnetic resonance imaging studies and hemorrhagic transformation on brain imaging studies during the acute presentation. Neurological outcome was assessed with the Pediatric Stroke Outcome Measure. We used univariate and multivariable ordinal logistic regression models to test the association between imaging characteristics and outcome. RESULTS: Univariate analysis demonstrated that infarcts involving uncinate fasciculus, angular gyrus, insular cortex, or that extended from cortex to the subcortical nuclei were significantly associated with poorer outcomes with odds ratios ranging from 1.95 to 3.95. All locations except the insular cortex remained significant predictors of poor outcome on multivariable analysis. When infarct volume was added to the model, the locations did not remain significant. Larger infarct volumes and younger age at stroke onset were significantly associated with poorer outcome, but the strength of the relationships was weak. Hemorrhagic transformation did not predict outcome. CONCLUSIONS: In the largest pediatric arterial ischemic stroke cohort collected to date, we showed that larger infarct volume and younger age at stroke were associated with poorer outcomes. We made the novel observation that the strength of these associations was modest and limits the ability to use these characteristics to predict outcome in children. Infarcts affecting specific locations were significantly associated with poorer outcomes in univariate and multivariable analyses but lost significance when adjusted for infarct volume. Our findings suggest that infarcts that disrupt critical networks have a disproportionate impact upon outcome after childhood arterial ischemic stroke.
Authors: Anna N Cooper; Vicki Anderson; Stephen Hearps; Mardee Greenham; Michael Ditchfield; Lee Coleman; Rod W Hunt; Mark T Mackay; Paul Monagle; Anne L Gordon Journal: Pediatrics Date: 2017-07-14 Impact factor: 7.124
Authors: Christine K Fox; Lori C Jordan; Lauren A Beslow; Jennifer Armstrong; Mark T Mackay; Gabrielle deVeber Journal: Int J Stroke Date: 2018-06-29 Impact factor: 5.266
Authors: Nawaf Yassi; Leonid Churilov; Bruce C V Campbell; Gagan Sharma; Roland Bammer; Patricia M Desmond; Mark W Parsons; Gregory W Albers; Geoffrey A Donnan; Stephen M Davis Journal: Int J Stroke Date: 2015-06-04 Impact factor: 5.266
Authors: Gregory W Albers; Vincent N Thijs; Lawrence Wechsler; Stephanie Kemp; Gottfried Schlaug; Elaine Skalabrin; Roland Bammer; Wataru Kakuda; Maarten G Lansberg; Ashfaq Shuaib; William Coplin; Scott Hamilton; Michael Moseley; Michael P Marks Journal: Ann Neurol Date: 2006-11 Impact factor: 10.422
Authors: Lori C Jordan; Nancy K Hills; Christine K Fox; Rebecca N Ichord; Paola Pergami; Gabrielle A deVeber; Heather J Fullerton; Warren Lo Journal: Neurology Date: 2018-07-06 Impact factor: 9.910
Authors: Laura L Lehman; Jane C Khoury; J Michael Taylor; Samrat Yeramaneni; Heidi Sucharew; Kathleen Alwell; Charles J Moomaw; Katrina Peariso; Matthew Flaherty; Pooja Khatri; Joseph P Broderick; Brett M Kissela; Dawn O Kleindorfer Journal: J Child Neurol Date: 2018-04-19 Impact factor: 1.987
Authors: Gabrielle A deVeber; Adam Kirton; Frances A Booth; Jerome Y Yager; Elaine C Wirrell; Ellen Wood; Michael Shevell; Ann-Marie Surmava; Patricia McCusker; M Patricia Massicotte; Daune MacGregor; E Athen MacDonald; Brandon Meaney; Simon Levin; Bernard G Lemieux; Lawrence Jardine; Peter Humphreys; Michèle David; Anthony K C Chan; David J Buckley; Bruce H Bjornson Journal: Pediatr Neurol Date: 2017-01-26 Impact factor: 3.372
Authors: Richard Idro; Amelia K Boehme; Michael Kawooya; Samson K Lubowa; Deogratias Munube; Paul Bangirana; Robert Opoka; Ezekiel Mupere; Angela Lignelli; Philip Kasirye; Nancy S Green; Frank J Minja Journal: J Stroke Cerebrovasc Dis Date: 2022-02-11 Impact factor: 2.136
Authors: Emily J Mastej; Michelle H Leppert; Sharon Poisson; Zak Ritchey; Megan Barry; Tatjana Rundek; David S Liebeskind; David Mirsky; Timothy J Bernard; Nicholas V Stence Journal: J Child Neurol Date: 2022-09-07 Impact factor: 2.363