Etiologic spectrum and neurological outcomes in pediatric arterial ischemic stroke and cerebral sinovenous thrombosis: A 15-Year retrospective study at a tertiary hospital

To evaluate clinical and radiological features, risk factors, etiology, treatment approaches, and outcomes of pediatric arterial ischemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT).

Children beyond the neonatal period diagnosed with AIS or CSVT between 2002 and 2017 were retrospectively analyzed. Demographics, clinical presentations, radiological findings, risk factors, etiologies, treatments, and outcomes were reviewed.

A total of 94 patients with AIS and 27 with CSVT were included. The median age for AIS patients was 4.1 years (IQR:1.6-9.8). Focal neurological deficits were present in 81.7%, hemiparesis being the most common symptom. Seizures were noted in 30.4%. Cardiac abnormalities (39%) and arteriopathies (38%) were the most common etiologies, with prothrombotic conditions and rare genetic disorders also remarkable underlying risk groups. Antithrombotic therapy was administered without major complications to 89.3%. At a median three-year follow-up, 33.8% had no neurological deficits, 33.8% had moderate to severe deficits or died, 16.2% had epilepsy. For CSVT, the median age was 9.6 years (IQR:3.2-12.6). Diffuse neurological symptoms were present in 77.7%, primarily headaches and vomiting. Seizures occurred in 22.2%. All CSVT patients had at least one risk factor. Chronic systemic conditions (63%) and infections (44%) were the most common risk factors. During follow-up of a median of 43 months, 63.6% had no neurological deficits.

Pediatric stroke has a broad spectrum of risk factors. Our study contributes to the existing knowledge on pediatric AIS and CSVT, providing a detailed overview of pediatric AIS and CSVT at a tertiary center, reflecting the growing awareness of physicians in childhood cerebrovascular diseases.