Abstract:
This study is a retrospective review of a population-based cohort of children
with diagnosis of posterior circulation arterial ischemic stroke (PAIS) in Manitoba.
Children were consecutively enrolled in the Canadian Pediatric Ischemic Stroke
Registry and the Manitoba Pediatric Stroke Database. We examined demographics,
clinical and radiological presentation, treatment and outcome of children with PAIS.
We also examined the clinical and radiological predictors of outcome in our study
cohort using the Pediatric Stroke Outcome Measure (PSOM).
Between 1992 and 2010, 24 patients met inclusion criteria, 54.2% male,
and average age 4.9 years. Follow-up data at 24 months was available for 20
patients. For pediatric PAIS in Manitoba, an incidence rate of 1 person per
10,000 if followed for 18 years was estimated. Our reported ratio of PAIS to AIS
is 20%, which corresponds with previous data of PAIS comprising 15-20% of AIS
with incidence of all AIS being 2.5 - 3/100,000 per year3-9. Warning symptoms
were present in one-third, and identifiable risk factors found in two thirds of the
cohort. We found poor outcomes in aboriginal patients (45.8%, p=0.003), high
PedsNIHSS score (p=0.02), patients with vasculopathy (25%, p=0.05), bilateral
infarcts (42%, p=0.003), large caliber artery infarcts (53%, p=0.02) and occipital
lobe infarcts (42%, p=0.04). Abnormalities found on vascular imaging (performed
in 62.5%) trended towards recurrence (p=0.07). Outcome at 3, 12 and 24 months
was correlated (p<0.001).
The incidence rate, as well as predictors of outcome and recurrence, is
valuable clinical information that will help direct treatment and prognostication of
children with PAIS.
