Factors predictive of outcome in childhood stroke in an Asian population

Introduction: While paediatric strokes are fairly uncommon, they are often associated with signifi cant long-term disability. Diagnosis is often delayed because of the need to exclude condi- tions that mimic stroke. Understanding the outcomes related to stroke in children is important in the development of secondary prevention strategies. The aim of this study was to evaluate the epidemiology of childhood stroke in a tertiary paediatric unit in Singapore and to assess factors infl uencing outcome in these children. Materials and Methods: A retrospective case- note review of all childhood strokes presenting to the Children's Medical Institute (CMI) at the National University Hospital (NUH), Singapore between October 1999 and May 2006. Data collected include demographic factors, clinical presentation, diagnosis, subsequent management and follow-up using specifi c outcome measures. Results: Twenty-six children with a median age of 8.0 years at presentation were identifi ed, comprising 15 ischaemic strokes (57.7%), 10 haemorrhagic strokes (38.5%) and 1 patient with both ischaemic and haemorrhagic lesions. The most common symptoms at presentation were seizures (15/26, 57.7%), lethargy (11/26, 42.3%), hemiparesis (10/26, 38.5%) and altered levels of consciousness (10/26, 38.5%). Vascular abnor- malities accounted for 50% of strokes in our study population. The average length of follow-up was 33.2 months (range, 1 to 120) with only 11 children (11/26, 42.3%) achieving full recovery. Signifi cant prognostic factors include altered consciousness and seizures at presentation, lesions in both cortical and subcortical locations, systemic disease aetiology, neurological defi cits at discharge and seizures at the time of discharge. Conclusion: Long-term neurological, neuropsy- chological and functional impairment are common in survivors of paediatric strokes. Certain clinical features and lesion characteristics are useful indicators of prognosis in these children. Ann Acad Med Singapore 2009;38:876-81