Risk Factors For Ischemic And Hemorrhagic Stroke In Children: Consequences On Therapy And Quality Of Life

The study was supported by a grant from The Vorarlberger Landesregierung/Federal government of Vorarlberg, Austria

Objektive: to examine children with stroke in a non-urban community, to calculate the incidence over a 22-years time period, to detect p risk factors of pediatric stroke; to determine long-term outcome by neurological investigation, neuropsychological test and quality of life (QOL) and to optimize medical therapy and rehabilitative techniques.

Patients: Discharge diagnosis codes from all hospitals of Vorarlberg/Austria of pediatric stroke (age >1 month and <19 years) from 1984–2005. We use a standardized investigation protocol with prospectively defined risk factors including MR-angiography, aquired and genetic prothrombin abnormalities and lipoproteins. Evalaution of long-term outcome consists of neurological deficit, neuropsychological test (e.g. Intelligence score) and quality of life.

Results: Twenty-two children with 16 ischemic and 6 hemorrhagic stroke were detected. The median age at onset was 6 (0.9–14) years. Incidence for arterial ischemic was 1.9 for hemorrhagic stroke 0.7/100.000 children years. In 20 children (12 male) with complete data median time of follow-up was 3.7 (0.4–18) years. No child died one child had a recurrent stroke. Risk factors were vasculopathies in 15/20 (75%), disorders of lipometabolism in 17 (85%), elevated lipoproteins in 11 (55%) and prothrombotic abnormality in 10 (50%) children. All except one child presented with at least one risk factor. We diagnosed hyperlipoproteinemia type IIa Fredrickson in two, á-lipoproteinemia and pro-â-lipoprotenemia in one child each. Nine (45%) childen had a moderate or severe neurological deficit, but only five of these had an additional deficit in their intelligence score and only in four the quality of life was reduced. In 13 of 20 (65%) children, participation in the study had therapeutic consequences due to new results obtained: aspirin was introduced in five, folic acid in three children and we started rehabilitative techniques, psychological advice and nutrition consulting in a total of nine (45%) children,

Conclusion: Almost all children with pediatric stroke have more than one risk factors. The most prominent are vasculaopathies and disorders in the lipometabolism, mainly elevation of lp(a). Long-term outcome is solely determined by neurological deficits and positively influenced by the results of neuropsychological test and quality of life.