ICNC Abstracts, ICNC 2018

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Acute Childhood stroke: observations from case series of 45 children from tertiary center in Mumbai
pradnya gadgil, Vineeta m, Mihir Munshi, Guruprasad Shanbhag

Last modified: 2018-09-09

Abstract


Paediatric stroke is rare but does occur. We have managed childhood stroke- piggy-backing on an existing robust adult stroke program in our hospital.

 

Methods: We undertook retrospective study of children presenting with acute stroke between 2011 – June 2018.

 

Results: 45 patients with stroke (15 females- 1 recurrence / 29 males; age 15 days - 18 years) presented within 0-8 days. Presenting symptoms: focal neurological deficits, headaches and altered sensorium. Delay in presentation was the norm!

 

I. Arterial ischemic strokes: 30 (MCA territory: 25; multiple arterial territories: 4; MRI contraindicated:1 )

  • Congenital heart disease: 7
  • Traumatic dissection: 4
  • Moya moya: 3
  • Transient cerebral arteriopathy: 2
  • Infective endocarditis: 2
  • Leptospirosis vasculitis: 1
  • Aortoarteritis: 1
  • Primary CNS angitis: 1.
  • No etiology: 9 (3 not fully investigated)

4 were thrombolysed (NIHSS 8-12) with full recovery/ no adverse events.

A 3 year old girl - mechanical thrombectomy done–NIHSS improved 14 to 2.

 

II. Transient ischemic attacks: 8 (3 multiple TIAs)

  • Moya moya disease: 4
  • HANDL: 1
  • Autoimmune vasculitis: 1

 

III. Hemorrhagic strokes: 3

  • Warfarin coagulopathy: 1
  • Aneurysmal rupture:1: neurointerventional embolization.

 

IV. Cerebral venous sinus thrombosis: 3

  • Cyanotic congenital heart disease/ dehydration: 1
  • TB meningitis: 1
  • MTHFR homozygous mutation: 1

All were anticoagulated with radiological and clinical reversal.

 

V. Stroke mimics: 2: extensively investigated: Negative motor focal seizures

 

Conclusion: This series reflects challenges in paediatric stroke: delayed presentation; delayed diagnosis; validity of offering and lost opportunities in treating acute paediatric strokes; dilemmas of long term anticoagulation and yet excellent outcomes in those treated acutely.

 


Keywords


Paediatric; stroke; thrombolysis; mechanical thrombectomy; anticoagulation; prothrombotic; cyanotic congenital heart disease;

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