Predictors of motor outcome after childhood arterial ischemic stroke.

Autor: Blackburn E; Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK., D'arco F; Radiology Department, Great Ormond Street Hospital, London, UK., Devito A; Radiology Department, Great Ormond Street Hospital, London, UK., Ioppolo R; Radiology Department, Great Ormond Street Hospital, London, UK., Lorio S; Biomedical Engineering Department, Kings College London, London, UK., Quirk B; Radiology Department, Great Ormond Street Hospital, London, UK., Ganesan V; UCL Great Ormond Street Institute of Child Health, London, UK.
Jazyk: angličtina
Zdroj: Developmental medicine and child neurology [Dev Med Child Neurol] 2021 Oct; Vol. 63 (10), pp. 1171-1179. Date of Electronic Publication: 2021 May 09.
DOI: 10.1111/dmcn.14914
Abstrakt: Aim: 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.
Method: 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.
Results: 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.
Interpretation: 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.
(© 2021 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.)
Databáze: MEDLINE
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