Posterior Circulation Stroke in Manitoba Children: A Population Based Longitudinal Study of Clinical Presentation and Outcome

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.