Gordon Anne L, Anderson Vicki, Ditchfield Michael, Coleman Lee, Mackay Mark T, Greenham Mardee, Hunt Rod W, Monagle Paul
Clinical Sciences Theme, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.
Pediatric Neuroscience Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK.
Int J Stroke. 2015 Oct;10(7):1068-73. doi: 10.1111/ijs.12489. Epub 2015 Apr 28.
Pediatric stroke outcome studies are often cross sectional in design. Prospective information regarding the clinical course following diagnosis is lacking, but may inform clinical management beyond the acute period.
To describe the outcome of arterial ischemic stroke in infants, children and adolescents at one-month and six-months post-stroke across health domains, and explore the relationship between lesion characteristics and early outcome with six-month adaptive behavior.
A single center prospective longitudinal study at a tertiary level children's hospital. Recruitment was undertaken from December 2007 to January 2012. Participants were children aged birth to 18 years presenting acutely with first diagnosed arterial ischemic stroke. Lesion characteristics on brain imaging were classified. Children were grouped according to age at diagnosis for analysis (neonates vs. those aged >30 days).
In 50 children with a median age of 47 months at diagnosis, sensorimotor impairments were most evident upon neurological examination acutely, especially in the older children. At both one-month and six-months motor functioning was significantly impaired in the older age group but no significant cognitive or language sequelae were identified. Lesion characteristics alone were not associated with six-month adaptive behavior outcomes.
For patients surviving arterial ischemic stroke, the most significant clinical consequences both acutely and at six-months, are sensorimotor impairments, particularly evident in the older children. In contrast cognitive or language sequelae were not identified. Long-term surveillance is required to describe clinical course and rehabilitation needs, particularly for neonates and infants.
儿童卒中结局研究通常采用横断面设计。缺乏关于诊断后临床病程的前瞻性信息，但这些信息可能有助于急性期后的临床管理。
描述婴儿、儿童和青少年动脉缺血性卒中后1个月和6个月时各健康领域的结局，并探讨病变特征与早期结局及6个月适应性行为之间的关系。
在一家三级儿童医院进行的单中心前瞻性纵向研究。招募时间为2007年12月至2012年1月。参与者为出生至18岁首次诊断为动脉缺血性卒中的急性患儿。对脑成像的病变特征进行分类。根据诊断时的年龄将儿童分组进行分析（新生儿与年龄>30天的儿童）。
50名诊断时中位年龄为47个月的儿童中，急性神经学检查时感觉运动障碍最为明显，尤其是年龄较大的儿童。在1个月和6个月时，年龄较大的组运动功能均有显著受损，但未发现明显的认知或语言后遗症。仅病变特征与6个月适应性行为结局无关。
对于动脉缺血性卒中存活的患者，急性和6个月时最显著的临床后果是感觉运动障碍，在年龄较大的儿童中尤为明显。相比之下，未发现认知或语言后遗症。需要长期监测以描述临床病程和康复需求，尤其是对于新生儿和婴儿。
