Manual Pediatric Stroke and Cerebrovascular Disorders

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Boys were at a higher risk than girls, and black children were at a higher risk than white and Asian children. In GBD study, the prevalence rate of ischemic stroke was 4- to 5-fold higher in developing countries, compared to that in developed countries, while the prevalence rate for hemorrhagic stroke was approximately 2-fold higher in developing countries. The result is higher than USA and Hong Kong results, but it is in the middle value when comparing with data worldwide.

Several conditions have been considered to be associated with pediatric stroke, including vascular disorders, cardiac disorders and infections. Sickle cell disease, thalassemia and metabolic disorders are important risks for pediatric ischemic stroke; and a number of prothrombotic conditions 31 are responsible for hemorrhagic stroke. A retrospective study at a single institution in Taiwan reported trauma and mitochondria diseases are also important conditions to be associated with pediatric ischemic stroke.

In the current study, we found vascular disorders 58 patients or Studies reported strokes recur in one fifth of cases of later childhood arterial ischemic stroke, implied these patients might have arteriopathy and suggested perform cerebrovascular imaging for later childhood arterial ischemic stroke. Severe infections were found to be the second common associated condition in our patients. There were 53 cases could find out pathogens, and the most common pathogens were influenza eight patients , pneumococcus pneumoniae seven patients , tuberculosis TB five patients and Mycoplasma pneumoniae five patients.

A study reported TB meningitis is still a risk factor for arterial ischemic stroke in Turkey, 36 addressed that TB is an important cause of stroke in children living in developing countries. However, it seems that TB is less common risk of stroke in Taiwan. Retrospective case series suggest that pediatric hemorrhagic stroke is most often due to AVM, hematologic abnormality or brain tumor, 37 this echoes our research results.

Stroke in children

Specifically, we found abusive head trauma or shaken baby are also important risks for children with hemorrhagic stroke in Taiwan. A study reported one or more strokes in a child with abusive head trauma indicate a particularly severe injury. These children have longer hospital stays, greater hospital charges and a greater likelihood of needing a neurosurgical intervention. From literatures, hematological diseases are responsible to pediatric hemorrhagic stroke, 39 especially aplastic anemia, idiopathic thrombocytopenia, hemophilia and other coagulation defects 40 can extremely rarely cause ischemic stroke when compared to intracranial hemorrhages.

However, we found that these diseases also account for some of the causes of ischemic stroke in children, especially thalassemia and coagulation defects. Studies favor hypocoagulable state of hemophilia and other coagulation defects patients might have a protective effect on thrombus, 41 , 42 thus the risk of ischemic stroke in hemophilia and other coagulation defects patients in current study is doubt.

These common risk factors included congenital vascular anomaly, congenital heart diseases, hematologic disorders, brain tumors and renal disorders. This report is the first comprehensive investigation of pediatric stroke in a cross-sectional nationwide scale.

What is pediatric stroke?

The most important contribution of this study is we categorized which risks were responsible for ischemic stroke or hemorrhagic stroke, and we found the causes of hemorrhagic stroke are significantly different from ischemic stroke. Similar to the most national database based studies, the major limitation is the heterogeneity of data from different centers. This would doubt the consistency of diagnosis and quality of cares. First, there is lack of immediate neurologic evaluation and neuroimaging study results in the database. Second, owing to no standardized records of neurologic evaluations, the collected clinical manifestation information in this study is limited.

The registry of catastrophic illness in patients HV —11 of the NHIRD is used as a proxy for identifying patients with stroke causing moderate and severe disabilities.


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Therefore, the percentage of patients with severe permanent neurologic deficits like death, level of consciousness, cerebral palsy, hemiplegia, central DI, hydrocephalus and long-term dependence on ventilator are all computed by linked analysis. Future studies through more detailed records of neurologic functions, laboratory test and neuroimaging study results are warranted to understand the recovery process in pediatric stroke.


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This research provides the largest nationwide, population-based study of childhood stroke in Taiwan. More than half of the stroke children had underlying diseases, including congenital vascular anomaly, infections, congenital heart diseases, hematologic disorders, CNS tumors, hematological diseases and chronic renal disorders. The contribution of this study is we completely categorized which risks were responsible for ischemic stroke or hemorrhagic stroke.

Furthermore, we found the causes of hemorrhagic stroke are significantly different from ischemic stroke. Because of the large patient cohort, this study provides important clinical information on the complete classification and etiological analysis of pediatric stroke would be a good guidance for the future research and management on this rare disease.

When stroke or transient ischemic attack occurs, a comprehensive survey should be performed and detailed history about the associated underlying diseases should be noted. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Materials and methods. Epidemiology, risk factors and characteristics of pediatric stroke: a nationwide population-based study K-L Chiang.

Department of Nutrition, Hungkuang University, No. Oxford Academic. Google Scholar. C-Y Cheng. Rd, Taipei , Taiwan, R. Cite Citation. Permissions Icon Permissions. Abstract Background. Table 2. Incidence of pediatric stroke basing on admission data in in current study. Figure 1. Open in new tab Download slide.

Treating Cerebral Vascular Disease

Figure 2. Figure 3.

Introduction

Figure 4. Prevalence and incidence of hemorrhagic and ischemic stroke among ages. Search ADS. Costs of pediatric stroke care in the United States: a systematic and contemporary review. Community-based case-control study of childhood stroke risk associated with congenital heart disease. Cerebral arteriovenous malformations in childhood: state of the art with special reference to treatment.

Cerebrovascular disease in children under 16 years of age in the city of Dijon, France: a study of incidence and clinical features from to Stroke in Saudi children. Epidemiology, clinical features and risk factors. Risk factors for pediatric stroke: consequences for therapy and quality of life. Recurrent hemorrhagic stroke in children: a population-based cohort study.

Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke. Imaging data reveal a higher pediatric stroke incidence than prior US estimates. Risk factors and clinical outcomes of childhood ischemic stroke in a single Korean tertiary care center. Urbanization and stroke prevalence in Taiwan: analysis of a nationwide survey. Prevalence, incidence, and stimulant use of attention-deficit hyperactivity disorder in Taiwan, a national population-based study.

Pediatric Cerebrovascular Disorders

Prevalence and neuro-psychiatric comorbidities of pediatric epilepsy in Taiwan: a national population-based study. Geographic variation in the age- and gender-specific prevalence and incidence of epilepsy: analysis of Taiwanese National Health Insurance-based data. Stroke prevalence, mortality and disability-adjusted life years in children and youth aged years: data from the global and regional burden of stroke Stroke in children: the coexistence of multiple risk factors predicts poor outcome.

Stroke in children within a major metropolitan area: the surprising importance of intracerebral hemorrhage. Cerebrovascular disease in infants and children: a study of incidence, clinical features, and survival. Arterial ischemic stroke risk factors: the International Pediatric Stroke Study. Risk of recurrent arterial ischemic stroke in childhood: a prospective international study.

Epidemiology and outcomes of arterial ischemic stroke in children: the Canadian Pediatric Ischemic Stroke Registry. Stroke in childhood: outcome and recurrence risk by mechanism in 59 patients. Childhood stroke: results of children from a reference center in Central Anatolia, Turkey. Stereotactic proton irradiation of cerebral arteriovenous malformations in patients with onset of disease in childhood.

Cardiovascular disease risk factors: prevalence and management in adult hemophilia patients.