FV 394. Childhood Arterial Ischaemic Stroke—Results of a German Nationwide Surveillance Study 2015 to 2017

Background: Childhood arterial ischemic stroke is rare but causes significant morbidity and mortality. Missing awareness and a broad spectrum of more common stroke mimics often lead to a considerable time delay in diagnosis and treatment. In childhood, thrombolysis and mechanical thrombectomy are off-label therapies and the possibility for the use of these therapeutic options depends on quick diagnosis and the underlying etiology. To identify each child’s individual risk profile is essential for therapy, outcome, and preventing recurrent stroke episodes.

Objective: The aim of this study was to provide German data for incidence, age-dependent clinical presentation, and risk factors of childhood arterial ischemic stroke and to describe the medical care situation of children with stroke regarding time to diagnosis, diagnostic work-up, hyperacute treatment, and medical aftercare.

Method: This prospective study was conducted via ESPED (Erhebungseinheit für Seltene Paediatrische Erkrankungen in Deutschland), a hospital-based German nation-wide Surveillance Unit for rare pediatric diseases. In a 3-year period between January 2015 and December 2017, pediatricians of 345 participating German children’s hospitals and pediatric departments were asked to report to ESPED children (28 days of life–18 years) with acute stroke and to fill out a questionnaire.

Results: Final results are forthcoming. The results of an interim analysis after 2 years (n = 99) are as follows: (1) The risk for arterial ischemic stroke depends on sex and age with incidence peaks in infants and children < 2 years of age and in adolescents from 12 years old onward. Male predominance was significant in the latter age group. (2) Focal neurological deficits were the leading symptom independent of age. Remarkable is the occurrence of seizures in infants and more nonspecific symptoms such as headache in elder children. Symptoms were acute in most children but were also described as progressive in some cases. (3) Prothrombotic abnormalities, cardiac disorders, and arteriopathies were the most common risk factors. Stroke was classified as cryptogenic in 25% of the children. (4) Hyperacute treatment modalities such as thrombolysis and mechanical thrombectomy were applied to 15/99 children and 9/99 children, respectively.

Conclusion: This study provides population-based data of childhood arterial ischemic stroke and reflects the current medical care situation of children with stroke in Germany. Future research could base on these results and focus, that is, on the significance of some single risk factors such as a patent foramen ovale or migraine and on endocrinological aspects in the pathomechanism of arterial ischemic stroke in male adolescents.