EPIDEMIOLOGY AND RISK FACTORS FOR CHILDHOOD STROKE IN CHINESE CHILDREN

Objective: To calculate the incidence of stroke in Chinese children in Hong Kong; and to examine the clinical spectrum, etiology, pattern, risk factors and outcome of pediatric stroke in Chinese.

Methods: Data of pediatric stroke (age 1 month to 16 years) from a single center has been prospectively collected as a “Children's Stroke Registry” since 1991. A retrospective study was performed from 1998 to 2001, using central computerized hospital discharge database, on all first hospital admissions for stroke in children aged 1 month to 14 years in Hong Kong island.

Results: Our study has included 4,545,300 person-years. In this 4-year period, 94 children with acute stroke were identified from the central hospital discharge database. The estimated incidence of pediatric stroke was 2.1 per 100,000 children-years. For our stroke registry, 50 children were included: 36 were ischemic and 14 were hemorrhagic. Of 36 ischemic strokes, 18 had cerebral thrombosis and 15 had cerebral embolism. Important causes included complications related to congenital heart diseases (N=15), vascular (N=13) and hematological (N=14) diseases. No sinovenous thrombosis was identified. Despite work-up, 12% remained undetermined. Ten percent (N=5) had recurrent strokes. The overall mortality was 18% (N=9 died). Long-term neurological deficit occurred in 41% of survivors, being mental retardation (N=11), epilepsy (N=7) and hemiplegia (N=10). Decreased level of consciousness, hematological causes and hemorrhagic transformation of ischemic stroke from neuroimaging predicted poor survival. The presence of seizure predicted long-term neurological deficit in survivors (p<0.05). Only decreased level of consciousness remained to be a significant risk factors for mortality (p=0.005) after multivariate analysis.

Conclusion: The incidence of stroke in southern Chinese children was in general similar or slightly lower than Europe or North America. The etiological pattern was different in our cohort. However, despite the differences, mortality and long term neurological deficit were similar.

Keywords: Chinese, children, Stroke, incidence, hemorrhage, ischemic