Stroke in children. Clinical characteristics and prognosis.

Cerebrovascular disease with acute hemiplegia or "stroke" in childhood is not rare and every possible effort must be made in order to improve the outcome for these patients. Acute hemiplegia and disturbance of consciousness are the most common initial signs. Twenty-seven children, 13 girls and 14 boys, with stroke have been investigated during a ten-year period. Hemorrhagic stroke was diagnosed in 14 cases, and ischemic stroke in 11 cases. In addition two cases with migraine accompagnée have been included. Neuroradiological examination was performed in all children, and neurosurgery in 11 cases with hemorrhagic stroke. In the ischemic stroke group, 55% presented a history of preceding infection. Over 90% of the children showed unilateral neurological signs in connection with ischemic stroke compared to 50% in hemorrhagic stroke, while the reverse frequency was observed as regards disturbances of consciousness. The mortality was 36% in hemorrhagic stroke and 18% in ischemic stroke. Among the children who survived, residual disabilities amounted to 75%. None has suffered a second stroke. The average annual incidence in childhood of hemorrhagic and ischemic stroke is 2.1/100 000/year. Some clinical characteristics and rules in the emergency approach to the hemiplegic child have been offered. The development of brain edema and the risk associated with lumbar puncture is emphasized. A child with stroke must without delay be transported to a hospital with access to neurosurgical expertise and neuroradiological facilities such at CAT scan and angiography.