POSTERIOR CIRCULATION STROKE IN CHILDHOOD: RISK FACTORS AND OUTCOME

Objectives: Objective: to describe the radiological and clinical features, risk factors and outcome of ischemic stroke in vertebrobasilar circulation.

Methods: review of 120 clinical charts of children with arterial ischemic stroke. We used the proposed pediatric stroke classification (E. Wrainge et al.)and the Pediatric Stroke Outcome Measure (G. de Veber et al).

Results: ten cases were identified. Acute initial symptoms: ataxia in 5, vomiting in 5, decreased level of consciousness in 5, headache in 4, seizures in 2 cases, visual deficit in 1 and hemiparesis in 1 case. MRI and CT revealed ischemic lesions in cerebellum (5), in occipital lobe (2), in cerebellum and pons (1), in pons and medulla (1) and in cerebellum and occipital lobe (1). Seven of eight cerebral angiographies (CA) and 3 of 6 MR angiographies (MRA) were abnormal. Involved arteries: posterior cerebral arteries (3), vertebral arteries (3), basilar arteries (2), posterior inferior cerebellar arteries (2) and superior cerebellar artery (1). Final Diagnosis: arterial dissection in 4, steno-occlusive cerebral arteriopathy in 4 and other determinated etiology in 2 cases (tuberculous meningitis and hypertension). The etiology of 4 patients remained unclear. Prothombotic risk factors were absent. Outcome: during a follow-up of 6 months to 14 years (median 6.3 years) 8 patients had a good outcome (five were normal and 3 had mild deficit). Recurrence: 1 case.

Conclusions: the initial symptoms and brain imagines revealed mostly cerebellum involvement. The diagnosis was clear when arterial dissection was found. Most of the patients had a good outcome. CA is usually indicated if a definitive diagnosis is not made on MRA.