Muhammad Akbar Malik, Muhammad Ziaur Rehman, Malik Muhammad Nadeem, Farooq Rasool, Abid Qureshi, Muhammad Nawaz, Hamza Malik.
Childhood arterial ischemic stroke (CAIS): evaluation, management and prognostic factors..
Pak Paed J Jan ;34(4):213-20.

Background: For childhood arterial ischemic stroke (cAIS) treatment trials are lacking and practice vary from centre to centre. Objectives: To describe clinical spectrum of cAIS and to investigate the safety of anticoagulants in ischaemic strokes. Study Type: Single centre, observational cohort study Place: The Department of the Neurosciences and the Neuroradiology of the Children’s Hospital Lahore-Pakistan. Period: 1st Jan 2009 to 30th November 2010. Methods: Over the period of 2 years, 68 patients with acute cAIS were admitted with arterial ischaemic strokes, within 05 days of onset of their symptoms and were treated with anticoagulants at least for 04 weeks. Patient were followed in hospital based cohort study at single center and were systemically assessed for clinical presentation, classification of cAIS, adverse effects of anticoagulants, hospital course, morbidity and mortality. Result: 68 children with cAIS (boys 62%, girls 38%) with mean age of 8.5 years (median age 7.4 + 3.5 years), were enrolled in this study. Motor deficit (70%); headache (64%) and fever (20%) were the commonest symptoms, whereas, hemiparesis (60%); seizure 55 % (focal 35%, generalized 20%); and decreased conscious level (30%), were the commonest neurological findings. Neuroradiological findings of head revealed; ischemic strokes 50 (73.5%); hemorrhagic strokes 10 (14.7%) and ischaemic haemorrhagic lesions 8(11.8%). No secondary hemorrhagic was documented among infarcts strokes, who were treated with heparin and anticoagulants. Hospital outcome was as; survivors 56 (81.5%) and deaths 12 (18.5%). Male sex, deep conscious level at presentation and intra-cerebral bleed causing severe raised intracranial pressure were the poor prognostic factor. The Neurological findings among 56 survivors were; normal 20%; minor disabilities 25%; moderate disabilities 20% and severe disabilities 35%. Conclusions: The findings from this study underline the significant mortality and morbidity of childhood strokes. It documents the safety of anticoagulants in ischaemic strokes.

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