Outcome and recurrence one year after paediatric arterial ischaemic stroke in a population-based cohort.

OBJECTIVE: Arterial ischaemic stroke (AIS) is an important cause of acquired brain injury in children. Few prospective population-based studies of childhood AIS have been completed. We aimed to investigate the outcome of childhood AIS 12 months after the event in a population-based cohort.

METHODS: Children aged 29 days to less than 16 years with radiologically confirmed AIS occurring over a 1-year period residing in southern England (population 5.99 million children) were eligible for inclusion. Outcome was assessed during a home-visit using the Paediatric Stroke Outcome Measure (PSOM). Parental impressions of recovery were assessed using the Paediatric Stroke Recurrence and Recovery Questionnaire (RRQ). PSOM score was estimated via telephone interview or clinician interview whenever home-visit was not possible.

RESULTS: 96 children with AIS were identified. 2 children were lost to follow-up. 9/94 (10%) of children died before the 12-month follow-up. One child had an AIS recurrence. PSOM scores were available for 78 of 85 living children at follow-up. 39/78 (50%) had a good outcome (total PSOM score <1) and 39/78 (50%) had a poor outcome. Seizures at onset of AIS were associated with a poor outcome (Odds Ratio 3.5 95% CI 1.16-10.6). 28/73 (38%) children were judged by their carers to have fully recovered. 10/84 (12%) of children had recurrent seizures and 17/84 (20%) reported recurrent headaches.

INTERPRETATION: AIS carries a significant risk of mortality and long-term neurological deficit. However, the rates of mortality, recurrence and neurological impairment were markedly lower in this study than previously published figures in the UK. This article is protected by copyright. All rights reserved.