Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, UK.
Neurosciences Unit, UCL Institute of Child Health, London, UK.
Lancet Neurol. 2014 Jan;13(1):35-43. doi: 10.1016/S1474-4422(13)70290-4. Epub 2013 Dec 2.
Arterial ischaemic stroke is an important cause of acquired brain injury in children. Few prospective population-based studies of childhood arterial ischaemic stroke have been undertaken. We aimed to investigate the epidemiology and clinical features of childhood arterial ischaemic stroke in a population-based cohort.
Children aged 29 days to less than 16 years with radiologically confirmed arterial ischaemic stroke occurring over a 1-year period (July 1, 2008, to June 30, 2009) residing in southern England (population denominator 5·99 million children) were eligible for inclusion. Cases were identified using several sources (paediatric neurologists and trainees, the British Paediatric Neurology Surveillance Unit, paediatricians, radiologists, physiotherapists, neurosurgeons, parents, and the Paediatric Intensive Care Audit Network). Cases were confirmed by personal examination of cases and case notes. Details of presenting features, risk factors, and investigations for risk factors were recorded by analysis of case notes. Capture-recapture analysis was used to estimate completeness of ascertainment.
We identified 96 cases of arterial ischaemic stroke. The crude incidence of childhood arterial ischaemic stroke was 1·60 per 100 000 per year (95% CI 1·30-1·96). Capture-recapture analysis suggested that case ascertainment was 89% (95% CI 77-97) complete. The incidence of arterial ischaemic stroke was highest in children aged under 1 year (4·14 per 100 000 per year, 95% CI 2·36-6·72). There was no difference in the risk of arterial ischaemic stroke between sexes (crude incidence 1·60 per 100 000 per year [95% CI 1·18-2·12] for boys and 1·61 per 100 000 per year [1·18-2·14] for girls). Asian (relative risk 2·14, 95% CI 1·11-3·85; p=0·017) and black (2·28, 1·00-4·60; p=0·034) children were at higher risk of arterial ischaemic stroke than were white children. 82 (85%) children had focal features (most commonly hemiparesis) at presentation. Seizures were more common in younger children (≤1 year) and headache was more common in older children (>5 years; p<0·0001). At least one risk factor for childhood arterial ischaemic stroke was identified in 80 (83%) cases.
Age and racial group, but not sex, affected the risk of arterial ischaemic stroke in children. Investigation of such differences might provide causative insights.
The Stroke Association, UK.
动脉缺血性中风是儿童获得性脑损伤的一个重要原因。很少有针对儿童动脉缺血性中风的前瞻性基于人群的研究。我们旨在调查人群中儿童动脉缺血性中风的流行病学和临床特征。
2008 年 7 月 1 日至 2009 年 6 月 30 日期间，居住在英格兰南部（人口基数为 599 万儿童）的经影像学证实的动脉缺血性中风发病年龄在 29 天至 16 岁以下的儿童符合入选条件。通过多种来源（儿科神经科医生和学员、英国儿科神经病监测单位、儿科医生、放射科医生、物理治疗师、神经外科医生、父母和儿科重症监护审计网络）确定病例。通过对病例和病历的个人检查来确认病例。通过分析病历记录了发病特征、风险因素和风险因素的检查详情。捕获再捕获分析用于估计确定的完整性。
我们确定了 96 例动脉缺血性中风。儿童动脉缺血性中风的粗发病率为每年每 10 万人 1.60 例（95%CI 1.30-1.96）。捕获再捕获分析表明，病例确定的比例为 89%（95%CI 77-97）。年龄在 1 岁以下的儿童中动脉缺血性中风的发病率最高（每年每 10 万人 4.14 例，95%CI 2.36-6.72）。男孩和女孩的动脉缺血性中风风险无差异（粗发病率男孩为每年每 10 万人 1.60 例（95%CI 1.18-2.12），女孩为每年每 10 万人 1.61 例（1.18-2.14））。亚洲人（相对风险 2.14，95%CI 1.11-3.85；p=0.017）和黑人（2.28，1.00-4.60；p=0.034）儿童患动脉缺血性中风的风险高于白人儿童。82（85%）例儿童在发病时存在局灶性特征（最常见的偏瘫）。癫痫发作更常见于年龄较小的儿童（≤1 岁），头痛更常见于年龄较大的儿童（>5 岁；p<0.0001）。在 80（83%）例病例中确定了至少一个儿童动脉缺血性中风的风险因素。
年龄和种族群体（而非性别）影响了儿童动脉缺血性中风的风险。对此类差异的研究可能会提供病因学见解。
英国中风协会。
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