Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK.
Radiology Department, Great Ormond Street Hospital, London, UK.
Dev Med Child Neurol. 2021 Oct;63(10):1171-1179. doi: 10.1111/dmcn.14914. Epub 2021 May 9.
To identify clinical and radiological predictors of long-term motor outcome after childhood-onset arterial ischemic stroke (AIS) in the middle cerebral artery (MCA) territory.
Medical records of 69 children (36 females, 33 males; median age at index AIS 3y 3mo, range: 1mo-16y) who presented to Great Ormond Street Hospital with first AIS in the MCA territory were reviewed retrospectively. Cases were categorized using the Childhood AIS Standardized Classification and Diagnostic Evaluation (CASCADE). Magnetic resonance imaging (MRI) and angiography were evaluated. An Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was calculated on MRI. The Recurrence and Recovery Questionnaire assessed motor outcome and was dichotomized into good/poor.
Eventual motor outcome was good in 49 children and poor in 20. There were no acute radiological predictors of eventual motor outcome. At follow-up, CASCADE 3A (i.e. moyamoya) and Wallerian degeneration were significantly associated with poor motor outcome. In the multivariate analysis, younger age and CASCADE 3A predicted poor motor outcome.
In the context of recommendations regarding unproven and potentially high-risk hyperacute therapies for childhood AIS, prediction of outcome could usefully contribute to risk/benefit analysis. Unfortunately, paradigms used in adults, such as ASPECTS, are not useful in children in the acute/early subacute phase of AIS. What this paper adds Adult paradigms, such as the Alberta Stroke Program Early Computed Tomography Score system, are not useful for predicting outcome in children. Younger children tend to have a poorer long-term prognosis than older children. Moyamoya is associated with poor prognosis.
确定儿童大脑中动脉（MCA）区域起病的动脉缺血性脑卒中（AIS）后长期运动预后的临床和影像学预测因素。
回顾性分析了 69 名儿童（36 名女性，33 名男性；指数 AIS 时的中位年龄为 3 岁 3 个月，范围为 1 个月-16 岁）在大奥蒙德街医院就诊的首次 MCA 区域 AIS 病例。病例使用儿童 AIS 标准化分类和诊断评估（CASCADE）进行分类。评估磁共振成像（MRI）和血管造影。在 MRI 上计算 Alberta 卒中计划早期计算机断层扫描评分（ASPECTS）。复发和恢复问卷评估运动预后，并分为良好/不良。
最终运动预后良好的有 49 例，不良的有 20 例。急性影像学无最终运动预后的预测因素。在随访时，CASCADE 3A（即烟雾病）和 Wallerian 变性与运动预后不良显著相关。多变量分析显示，年龄较小和 CASCADE 3A 预测运动预后不良。
在关于儿童 AIS 未经证实和潜在高风险的超急性期治疗的建议的背景下，预后预测可以有助于风险/效益分析。不幸的是，在急性/早期亚急性期，成人使用的范例，如 Alberta 卒中计划早期计算机断层扫描评分系统，对儿童没有用。本研究的意义 成人范例，如 Alberta 卒中计划早期计算机断层扫描评分系统，对于预测儿童的预后没有用。年龄较小的儿童比年龄较大的儿童预后较差。烟雾病与预后不良相关。
