Department of Neurology, Royal Children's Hospital, Parkville, Vic., Australia.
Murdoch Children's Research Institute, Parkville, Vic., Australia.
Dev Med Child Neurol. 2018 Nov;60(11):1117-1122. doi: 10.1111/dmcn.13772. Epub 2018 Apr 14.
To estimate the strengths of association between clinical features and migraine or arterial ischaemic stroke (AIS) in children presenting to the emergency department.
Eighty-four children with migraine, prospectively recruited from 2009 to 2010, were compared with 55 children with AIS, prospectively/retrospectively recruited from 2003 to 2010. Odds ratios were calculated via logistic regression to measure associations between clinical features and process-of-care factors, and migraine and AIS.
Median age was 13 years 5 months (interquartile range 12y 11mo-13y 10mo) for migraine and 5 years (interquartile range 3y 7mo-8y) for patients with AIS. All cases of AIS and 30% of migraine cases underwent neuroimaging. Over 40% of children with migraine had vomiting, numbness, or visual disturbance; other symptoms were uncommon. Fifty-five per cent had no signs on physician assessment. Weakness or speech disturbance were common in patients with AIS. Significant clinical features associated with increased odds of AIS included sudden symptom onset, weakness, seizures, speech disturbance, and ataxia, and signs of face, arm, or leg weakness, inability to walk, dysarthria, dysphasia, and altered consciousness (p<0.05). Significant features associated with decreased odds of AIS included older age, vomiting, visual, sensory, other symptoms, and absent focal signs on assessment (p<0.05).
Presenting features can discriminate childhood AIS from migraine. These differences inform decisions about urgency and type of neuroimaging in children presenting to the emergency department with brain attack symptoms.
Weakness, seizures, ataxia, speech, or walking difficulties are more frequent in arterial ischaemic stroke (AIS). Vomiting, visual, or sensory disturbance and absent focal signs are more frequent in migraine. Identifying features of AIS and migraine guides neuroimaging in children with brain attack symptoms.
评估在急诊科就诊的儿童中，临床特征与偏头痛或动脉缺血性卒中（AIS）之间的关联强度。
2009 年至 2010 年前瞻性招募了 84 例偏头痛患儿，并与 2003 年至 2010 年前瞻性/回顾性招募的 55 例 AIS 患儿进行比较。通过逻辑回归计算比值比，以测量临床特征和治疗过程因素与偏头痛和 AIS 之间的关联。
偏头痛患儿的中位年龄为 13 岁 5 个月（四分位距 12y 11mo-13y 10mo），AIS 患儿的中位年龄为 5 岁（四分位距 3y 7mo-8y）。所有 AIS 病例和 30%的偏头痛病例均进行了神经影像学检查。超过 40%的偏头痛患儿有呕吐、麻木或视觉障碍；其他症状罕见。55%的偏头痛患儿医生评估无体征。AIS 患儿常见乏力或言语障碍。与 AIS 发生几率增加相关的显著临床特征包括症状突然发作、乏力、癫痫发作、言语障碍和共济失调，以及面部、手臂或腿部无力、无法行走、构音障碍、失语和意识改变（p<0.05）。与 AIS 发生几率降低相关的显著特征包括年龄较大、呕吐、视觉、感觉、其他症状以及评估时无局灶体征（p<0.05）。
表现出的特征可以区分儿童 AIS 和偏头痛。这些差异为在急诊科就诊的有脑卒症状的儿童提供有关紧急程度和神经影像学类型的决策信息。
乏力、癫痫发作、共济失调、言语或行走困难在 AIS 中更常见。呕吐、视觉、感觉障碍和无局灶体征在偏头痛中更常见。识别 AIS 和偏头痛的特征有助于指导有脑卒症状的儿童进行神经影像学检查。
