Vázquez López María, de Castro de Castro Pedro, Barredo Valderrama Estibaliz, Miranda Herrero Ma Concepción, Gil Villanueva Nuria, Alcaraz Romero Andrés J, Pascual Pascual Samuel I
Department of Neuropaediatrics, H.G.U Gregorio Marañón, Madrid, Spain.
Department of Neuropaediatrics, H.G.U Gregorio Marañón, Madrid, Spain.
Eur J Paediatr Neurol. 2017 Sep;21(5):730-737. doi: 10.1016/j.ejpn.2017.05.007. Epub 2017 Jun 1.
Arterial ischemic strokes (AIS) are rare in childhood. Congenital and acquired heart diseases are one of the most important risk factors of AIS in children.
Study the outcome of children with heart disease that have suffered AIS and the factors that influence on prognosis.
We evaluated all children with heart disease who had suffered AIS between 2000 and 2014 in our hospital.
Seventy-four children with heart disease suffered an arterial ischemic stroke. 20% of them died and 10% had new AIS during the study period. Fifty-two patients were evaluated an average of six years after AIS. According to the Paediatric Stroke Outcome Scale (PSOM), most of the patients had some degree of impairment, mainly in sensorimotor and in cognitive-behavioural areas. The modified Rankin scale (mRS) showed an unfavourable outcome in 70% of patients (including patients that have died). Upper limb was more functionally impaired than lower limb. Strokes in neonatal period and early life were associated with poor prognosis. Size of stroke, cortical and subcortical involvement and basal ganglia stroke were associated with an unfavourable outcome. Fever in the acute phase and hemiparesis at presentation were also poor prognostic factors. Epilepsy at time of evaluation was also associated with unfavourable outcome. On the other hand, a normal electroencephalogram was associated with favourable outcome.
AIS in children with heart disease had an unfavourable outcome, with impairment in different areas. Epilepsy happened in one third of the patients.
动脉缺血性卒中（AIS）在儿童期较为罕见。先天性和后天性心脏病是儿童AIS最重要的危险因素之一。
研究患有AIS的心脏病患儿的预后情况以及影响预后的因素。
我们评估了2000年至2014年在我院发生AIS的所有心脏病患儿。
74名患有心脏病的儿童发生了动脉缺血性卒中。在研究期间，其中20%死亡，10%发生了新的AIS。52名患者在AIS发生后平均6年接受了评估。根据儿童卒中预后量表（PSOM），大多数患者有一定程度的损伤，主要在感觉运动和认知行为领域。改良Rankin量表（mRS）显示70%的患者预后不良（包括已死亡的患者）。上肢功能受损比下肢更严重。新生儿期和生命早期的卒中与预后不良有关。卒中大小、皮质和皮质下受累以及基底节卒中与预后不良有关。急性期发热和就诊时偏瘫也是不良预后因素。评估时癫痫也与预后不良有关。另一方面，脑电图正常与预后良好有关。
患有心脏病的儿童发生AIS预后不良，在不同领域存在损伤。三分之一的患者发生了癫痫。
