Ganesan, Vijeyarani; (1999) The aetiology, investigation and outcome of ischaemic stroke in childhood. Doctoral thesis (M.D), University of London, Institute of Child Health.

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Abstract

The aetiology, investigation and outcome of ischaemic stroke were studied in a population of 128 children. Cerebrovascular abnormalities were present in the majority of children; in many cases these conformed to specific diagnostic categories, with implications for management. In contrast, previously unrecognised non-vascular risk factors for stroke were relatively rare. In particular, the prevalence of inherited prothrombotic states was no higher in children with stroke than in control populations. Although magnetic resonance angiography was useful in identifying cerebrovascular lesions, conventional cerebral angiography had a continuing and definable role in the investigation of the child with ischaemic stroke. In the investigation of outcome after ischaemic stroke a simple questionnaire investigating parents' perception of residual disability was shown to correlate well with therapists' and neuropsychological assessment. Over half the children in this population had significant residual deficits; the incidence of recurrent stroke was 17% over 5 years. A younger age at the time of stroke was associated with worse outcome. However, prognosis was not influenced by other clinical factors. In a subgroup of 38 children with lesions in the territory of a middle cerebral artery, although the location of the lesion was not related to outcome, outcome was poor in all patients who had infarcted at least 10% of intracranial volume had. Lesion size could, therefore, be used to identify patients at high risk of long term disability for future treatment trials. These findings support the view that there is a role for both acute treatment and secondary prevention in children with ischaemic stroke. This study has characterised in detail a large population of children with ischaemic stroke and has given rise to several practical recommendations about the investigation and management of such patients.

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