Presentation of 16 paediatric patients manifesting with stroke during 2006–2010

Introduction: Childhood stroke has an estimated incidence of about 10:100000 per year. Nevertheless stroke is one of the 10 most common causes for death in childhood. We were interested in the mean diagnostic delay and presenting symptoms of pediatric patients referred to our University Hospital.

Method: We retrospectively analyzed the history of 16 patients (9 girls, 7 boys) with childhood stroke. Age at presentation varied from 2 months to 17.8 years. Initial symptoms were unspecific with vomiting in 4, collaps 2, headache1 and followed by specific signs of hemiparesis 12, aphasia 3, central facial palsy 2, seizure2, nystagmus 1, vertigo 1. Time delay from onset of symptoms to diagnosis by MRI ranged from 2h to 18 days (mean 58.7h±116). All patients were imaged by a 1.5 Tesla MRI, only 1 child had a CT due to orthodontic therapy. With respect to the vascular territory 9 had ischemic stroke of the medial cerebral artery, 4 of the posterior cerebral artery, 2 of the cerebellar artery. 1 had cerebral sinus venous thrombosis (CSVT). As underlying etiology we identified: heart disease 4, dissection 2, chemotherapy with lung cancer 1, chronic inflammatory bowel disease 1, otitis media 1 (CSVT), post varicella zoster vasculitis 1.

Screening for thrombophilia revealed homozygosity for MTHFR(677T) in 2, heterozygosity in 3, positive lupus inhibitor in 2.

Conclusions: As illustrated by this cohort the diagnosis of childhood stroke is still associated with marked diagnostic delay despite specific and acute neurologic deficits. Though in childhood stroke the option of lysis is only considered on an individual basis, the critical time window is often elapsed before a diagnosis was made. This illustrates that broader general awareness and logistic guidelines are needed to improve medical care of childhood stroke in pediatric centers.