Department of Pediatric Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.
Ann Neurol. 2011 Aug;70(2):245-54. doi: 10.1002/ana.22427.
The aim of this study was to compare children and young adults with acute ischemic stroke (AIS) in 2 large registries.
We compared clinical characteristics, stroke etiology, workup, and outcome (modified Rankin scale score [mRS] at 3-6 months) in children (1 month-16 years) and young adults (16.1-45 years) with AIS. Data of children were collected prospectively in the nationwide Swiss NeuroPediatric Stroke Registry, young adults in the Bernese stroke database. Outcome (mRS) and stroke severity (pediatric adaptation of the National Institutes of Health stroke scale [PedNIHSS]) in children were calculated retrospectively.
From January 2000 to December 2008, 128 children and 199 young adults suffered from an AIS. Children were more likely to be male than young adults (62%/49%, p = 0.023) and less frequently had hypertension (p = 0.001), hypercholesterolemia (p = 0.003), and a family history of stroke (p = 0.048). Stroke severity was similar in children and young adults (median PedNIHSS/NIHSS 5/6; p = 0.102). Stroke etiology (original TOAST classification) was more likely to be "other determined cause" in children than in young adults (51%/29%; p < .001). Cervicocerebral artery dissections were less frequent in children than in young adults (10%/23%; p = 0.005). Outcome at 3 to 6 months did not differ between children and young adults (p = 0.907); 59% of children and 60% of young adults had a favorable outcome (mRS 0-1). Mortality was similar among children and young adults (4%/6%; p = 0.436). In multivariate analysis, low PedNIHSS/NIHSS was the most important predictor of favorable outcome (p < 0.001).
Although stroke etiology and risk factors in children and young adults are different, stroke severity and clinical outcome were similar in both groups.
本研究旨在比较 2 个大型登记处中儿童和青年急性缺血性脑卒中（AIS）患者的临床特征。
我们比较了儿童（1 个月至 16 岁）和青年（16.1 至 45 岁）AIS 患者的临床特征、脑卒中病因、检查和结局（3 至 6 个月时改良 Rankin 量表评分[mRS]）。儿童数据前瞻性收集于全国瑞士神经儿科脑卒中登记处，青年数据收集于伯尔尼脑卒中数据库。儿童结局（mRS）和脑卒中严重程度（国家卫生研究院脑卒中量表的儿科改编版[PedNIHSS]）通过回顾性计算得出。
2000 年 1 月至 2008 年 12 月期间，128 名儿童和 199 名青年患有 AIS。与青年相比，儿童更可能为男性（62%/49%，p = 0.023），且高血压（p = 0.001）、高胆固醇血症（p = 0.003）和脑卒中家族史（p = 0.048）的发生率较低。儿童和青年的脑卒中严重程度相似（中位数 PedNIHSS/NIHSS 为 5/6；p = 0.102）。根据原始 TOAST 分类，儿童脑卒中病因更可能为“其他确定病因”，而青年则更可能为“不明原因”（51%/29%；p <.001）。儿童颈内动脉夹层较青年少见（10%/23%；p = 0.005）。3 至 6 个月时的结局在儿童和青年之间无差异（p = 0.907）；59%的儿童和 60%的青年结局良好（mRS 0-1）。儿童和青年的死亡率相似（4%/6%；p = 0.436）。多变量分析显示，低 PedNIHSS/NIHSS 是良好结局的最重要预测因素（p < 0.001）。
尽管儿童和青年的脑卒中病因和危险因素不同，但两组的脑卒中严重程度和临床结局相似。
