Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
Ann Neurol. 2020 Jun;87(6):840-852. doi: 10.1002/ana.25718. Epub 2020 Apr 6.
To characterize predictors of recovery and outcome following pediatric arterial ischemic stroke, hypothesizing that age influences recovery after stroke.
We studied children enrolled in the International Pediatric Stroke Study between January 1, 2003 and July 31, 2014 with 2-year follow-up after arterial ischemic stroke. Outcomes were defined at discharge by clinician grading and at 2 years by the Pediatric Stroke Outcome Measure. Demographic, clinical, and radiologic outcome predictors were examined. We defined changes in outcome from discharge to 2 years as recovery (improved outcome), emerging deficit (worse outcome), or no change.
Our population consisted of 587 patients, including 174 with neonatal stroke and 413 with childhood stroke, with recurrent stroke in 8.2% of childhood patients. Moderate to severe neurological impairment was present in 9.4% of neonates versus 48.8% of children at discharge compared to 8.0% versus 24.7% after 2 years. Predictors of poor outcome included age between 28 days and 1 year (compared to neonates, odds ratio [OR] = 3.58, p < 0.05), underlying chronic disorder (OR = 2.23, p < 0.05), and involvement of both small and large vascular territories (OR = 2.84, p < 0.05). Recovery patterns differed, with emerging deficits more common in children <1 year of age (p < 0.05).
Outcomes after pediatric stroke are generally favorable, but moderate to severe neurological impairments are still common. Age between 28 days and 1 year appears to be a particularly vulnerable period. Understanding the timing and predictors of recovery will allow us to better counsel families and target therapies to improve outcomes after pediatric stroke. ANN NEUROL 2020;87:840-852.
描述儿科动脉缺血性卒中后恢复和结局的预测因素，假设年龄会影响卒中后的恢复。
我们研究了 2003 年 1 月 1 日至 2014 年 7 月 31 日期间参加国际儿科卒中研究的儿童患者，在动脉缺血性卒中后进行了 2 年的随访。通过临床医生分级在出院时和通过儿科卒中结局量表在 2 年时定义结局。检查了人口统计学、临床和影像学结局预测因素。我们将出院到 2 年时的结局变化定义为恢复（结局改善）、新出现的缺陷（结局恶化）或无变化。
我们的研究人群包括 587 例患者，其中 174 例为新生儿卒中，413 例为儿童卒中，儿童患者中有 8.2%发生复发性卒中。与新生儿相比，出院时中至重度神经功能障碍分别为 9.4%和 48.8%，2 年后分别为 8.0%和 24.7%。不良结局的预测因素包括 28 天至 1 岁（与新生儿相比，比值比 [OR] = 3.58，p < 0.05）、基础慢性疾病（OR = 2.23，p < 0.05）和小血管及大血管病变同时累及（OR = 2.84，p < 0.05）。恢复模式不同，1 岁以下儿童新发缺陷更为常见（p < 0.05）。
儿科卒中后的结局通常较好，但中至重度神经功能障碍仍然常见。28 天至 1 岁似乎是一个特别脆弱的时期。了解恢复的时间和预测因素将使我们能够更好地为患者家属提供咨询，并针对治疗以改善儿科卒中后的结局。
