神経学的障害

A Prospective Study Evaluating the Clinical Profile of Pediatric Stroke in Western Rajasthan

Abstract

Manish Parakh, Vanny Arora and Birbal Khilery

Objective: To delineate the profile of pediatric patients with stroke in Western Rajasthan.

Methods: This was a hospital based prospective follow-up study carried out over a period of one year. In the study all admitted patients (6 m-18 years old) fulfilling the both clinical and radiological criteria (CT Scan/MRI) for stroke were enrolled (n=50). Epidemiological profile, clinical parameters and complications of these 50 patients were analyzed.

Results: 50 patients of stroke (as per case definition) were admitted in our institute over a period of one year out of which 64% were males (n= 32) and 36% were females(n=18) with a ratio of 1.78:1. 48% patients were in age group of 6 to 24 months (n=24); with a overall mean age of presentation of 52.8 ± 51.0 months. 74% (n=37) of the patients had Arterial Ischemic stroke (AIS); 8% (n=4) had Cerebral Sinus Venous Thrombosis (CSVT); 6% (n=3) had hemorrhagic stroke; 12% (n=6) had AIS coexisting with CSVT and hemorrhagic stroke. AIS was most commonly seen in age group of 6-24 months of age (45.95%); CSVT was most commonly seen among children of 60-120 months (50%); Combined type of stroke was seen only in patients between age group of 6-60 months. Anterior circulation was most common circulation involved in patients of stroke at all ages (63%), followed in frequency by combination of both anterior and posterior circulation (28.3%) and posterior circulation alone (8.7%). Involvement of both hemispheres of the brain together was slightly more common (36%) than either right side alone (34%) or left side alone (30%). Middle cerebral artery (MCA) territory stroke was the most common territory to be involved at all ages (45.6%). Isolated Posterior cerebral artery (PCA) & Internal carotid artery (ICA) territory stroke were more common (28.6%) in children >120 months. Involvement of more than one vessel territory was seen in children between 6-24 months (20.8%) and 24-60 months (44.4%) of age. Seizures were reported in 80% (n=40) of children amongst which 45% (n=18) had generalized seizures and 55% (n=22) had focal seizures. In patients with AIS, focal seizures were more common (54%) than generalized seizures. Patients who had CSVT type of stroke, only 50% patients had seizures. All hemorrhagic stroke patients presented with generalized seizure. Impairment of consciousness was seen in 50% of stroke patients. Consciousness was most commonly affected in patients of hemorrhagic stroke (100%). Co-morbid conditions were seen in 58% patients and Neurotuberculosis was the most common (22%) co-morbid condition associated with patients of stroke. Hemiparesis was the most common (66%) mode of presentation followed by facial palsy (26%). 26% (n=13) patients of stroke had no neurological deficit at the time of discharge and 36% (n=18) patients had mild to moderate neurological deficit, 30% (n=15) had severe deficit and 8% (n=4) patients expired.

Conclusion: Thus stroke in childhood is an important issue to be addressed as it is not uncommon as previously thought and is an important cause of morbidity and mortality. Despite excellent advances in clinical care and increasing availability of infrastructure, newer medicines and technology, the exact clinic-epidemiologic profile of both adult and pediatric stroke in Western Rajasthan is still not available. The current study has therefore been designed to evaluate the clinic-radiologic profile of pediatric stroke and to see whether stroke profile, mode of presentation and outcome of