Article

Little is known about basilar artery stroke (BAS) in children.
The objective
of this study was to calculate the incidence of BAS in children and to analyse
the clinical presentation, risk factors, radiological findings, therapeutic
approaches, and outcome of BAS in childhood. METHOD: A prospective,
population-based study including children with arterial ischaemic stroke and a
systematic review of the literature was undertaken. RESULTS: Seven children with
BAS were registered at the Swiss Neuropaediatric Stroke Registry between January
2000 and June 2011 (incidence 0.037 per 100,000 children per year, 95% confidence
interval [CI] 0.013-0.080). A further 90 cases were identified through the
literature search. The majority of patients were male (73 males, 24 females) and
the median age was 9 years (interquartile range [IQR]=6-13y). The median
Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score was 15
(IQR=4-27). Presenting signs and symptoms comprised impaired consciousness
(n=64), quadri- or hemiparesis (n=58), bulbar dysfunction (n=46), vomiting,
nausea (n=43), and headache (n=41). Prodromes occurred in 43% of cases. Aetiology
was largely vasculopathic (n=38), but often unknown (n=40). Time to diagnosis
varied from hours days; six patients received antithrombotic, thrombolytic, or
mechanical endovascular treatment 12 hours or less after symptom onset. Outcome
was good (modified Rankin Scale 0-2) in 45 patients; eight died. PedNIHSS score
of up to 17 was a prognostic factor for good outcome. INTERPRETATION: BAS is rare
in children. Compared with adults, outcome is more favourable despite a
considerable delay in diagnosis and treatment. Outcome was better in children
with a PedNIHSS score of 17 or less.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2012 Mac Keith Press.
Enfant

Langue : ANGLAIS