Pediatric Stroke from Bench to Bedside: A Single-Center Experience in Saudi Arabia

Abstract

Purpose

Stroke is a leading cause of severe long-term disability and death worldwide. This study aimed to determine the genetic background, causative factors, and diagnostic and outcome measures of pediatric stroke in an area endemic to sickle cell disease (SCD).

Patients and Methods

This retrospective review analyzed pediatric patients with acute stroke who were admitted to King Fahd Hospital of the University, Eastern Province, Saudi Arabia, between January and June 2019. We assessed 49 cases based on computed tomography (CT) and magnetic resonance imaging (MRI) findings. Patients with incomplete records or unavailable radiological images were excluded.

Results

A high likelihood of familial coexistence of stroke was detected in patients with affected siblings (33%). Among various central nervous system manifestations, motor weakness (28.6%) and headache (20.4%) were the most common symptoms/signs. Hypoxic-ischemic encephalopathy (HIE) (28.6%), SCD (22.5%), and moyamoya disease (14.3%) were the most prevalent underlying etiologies. CT without intravenous contrast was the most used initial imaging technique (92.5%). An arterial blockage was more prevalent (53.4%) than a venous infarct (46.6%) (p = 0.041), while arterial ischemic stroke was more prevalent (56.5%) than hemorrhagic stroke (43.5%). The middle cerebral artery (MCA) was most affected (63.5%), followed by the anterior cerebral artery (22.7%) and posterior cerebral artery (13.6%). Most patients were managed with medical treatment (86.1%). No mortalities occurred during the initial hospital stay. The mean length of hospital stay was 12 days.

Conclusion

HIE was the most prevalent etiology of pediatric stroke. Motor weakness and headache were the most common initial manifestations. Arterial ischemic stroke was more prevalent than venous or hemorrhagic stroke. Considering the rarity of pediatric stroke, future studies should be performed with a aborative effort nationally and internationally.

Keywords:

• magnetic resonance imaging
• computed tomography
• ischemic stroke
• hemorrhagic stroke
• paediatric

Abbreviations

AHA, American Heart Association; AIS, arterial ischemic stroke; AWI, arterial wall imaging; CT, computed tomography; CTA, computed tomography angiography; CVST, cerebral venous sinus thrombosis; HIE, hemorrhagic ischemic encephalopathy; MCA, middle cerebral artery; MRA, magnetic resonance arteriography; MRI, magnetic resonance imaging; MRV, magnetic resonance venography; SCD, sickle cell disease; tPA, tissue plasminogen activator.

Data Sharing Statement

The datasets generated and/or analyzed during the current study are not publicly available due to restrictions (eg, their containing information that could compromise the privacy of research participants). The anonymized data are available from the corresponding author on reasonable request. AS is the principal investigator and corresponding author for this project. AS should be contacted for data from this study ([email protected]).

Ethical Approval and Consent to Participate

The non-experimental study protocol was approved by the Imam Abdulrahman Bin Faisal University licensing committee of Institutional Review Board (IRB ‐2019‐01‐366), and granted approval for the study to be conducted at King Fahd Hospital University. This study was performed in accordance with the Helsinki Declaration of 1975 (revised in 1983). Anonymized data were ected, analyzed, and reported only in aggregate form, and no identifiable participant information (image, face, name etc.) was revealed in the study. Informed consent was obtained from all subjects and/or their legal guardian(s).

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; they took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in relation to this work.

Additional information

Funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.