Predictors Of Stroke Outcome In Chidren
Predictors Of Stroke Outcome In Chidren
Stroke can be defined as an abrupt loss of brain function that is caused by decreased
 cerebral blood flow.

 Stroke can occur at all stages of life, but presentation is variable depending on age,
 involved artery, and underlying risk factors.
Introduction Stroke can be defined as an abrupt loss of brain function that is caused by
 decreased cerebral blood flow.

 Stroke can occur at all stages of life, but presentation is variable depending on age,
 involved artery, and underlying risk factors.

 Younger children usually present with non specific symptoms such as seizures and altered
 mental status, especially those younger than 1 year, whereas older children present with
 focal neurologic deficits such as hemiplegia.(Rosa M et al ., 2016) Types pediatric stroke
 can be divided into ischemic and hemorrhagic stroke. Ischemic stroke is defined as focal
 damage to an area of brain tissue within a vascular territory due to loss of blood flow or
 oxygenation. It differs from diffuse hypoxic-ischemic injury in its mechanisms and
 distribution. Ischemic stroke, which represents 55% of pediatric strokes, can be subdivided
 into injuries caused by arterial ischemic stroke (AIS), which is due to loss of arterial
 flow, or venous infarction, which is due to loss of flow in a draining cerebral vein or
 venous sinus. Cerebral sinovenous thrombosis (CSVT), which involves obstruction by clot of a
 major venous sinus draining the brain parenchyma, can lead to infarcted brain parenchyma;
 Hemorrhagic stroke includes spontaneous hemorrhage within the brain parenchyma
 (intraparenchymal hemorrhage) and spontaneous (nontraumatic) subarachnoid hemorrhage. (Miya E
 et al.,2016) Risk factors Risk factors for stroke in children differ from those in adults.
 Adult risk factors are centered mainly on obstructive atherosclerotic, arteriopathies,
 cardiovascular disease, and arrhythmias, which are seldom found as risk factors in children.
 Stroke in children occurs primarily through 2 mechanisms, ischemic and hemorrhagic.

 The most common cause of ischemic stroke is thrombotic, which occurs more commonly in
 children, representing 30% to 60% of cases. Although less common in children, hemorrhagic
 stroke is mainly caused by arteriovenous malformation.1 Studies such as the International
 Pediatric Stroke Study (IPSS) have reported systemic risk factors for pediatric stroke
 including sickle cell disease, cardiac disorders, trauma, and major infections such as
 meningitis, sepsis, and encephalitis, but in most cases, no systemic disease was found.(Rose
 M et al ., 2015) &(Simma B et al., 2013) Outcome of stroke Outcome of arterial ischemic
 stroke (AIS) in children is considered more favorable than in adults due to the better brain
 plasticity in children. However, several studies showed that more than half of survivors of
 childhood AIS have long-term physical disabilities and cognitive impairment. (Studer M et al
 .,2014) Although stroke etiolog and risk factors were different, stroke severity and clinical
 outcomes were similar (Bigi S et al .,2011) younger age at stroke is associated with poorer
 intellectual outcome and a broader spectrum of dysfunctions across multiple
 neuropsychological domains.(Allman C et al.,2013) Further, children with combined cortical
 and subcortical lesions have overall poorer cognitive outcome,(Westmacott R et al,.2010)
 larger lesion size negatively influences cognitive and functional outcome, possibly due to
 disruption of more neural network connections, adversely affecting functional brain
 organization.(Long B et al., 2011).

 Regarding lesion laterality, controversial reports exist concerning the effect of lesion
 laterality on neuropsychological outcome. In addition, persistent seizures and persistent NI
 such as hemiplegia/paresis or visual field deficits also negatively influence
 neuropsychological and functional outcome. . (Allman C et al.,2013) NeuroImaging Brain
 magnetic resonance imaging (MRI) as more sensitive than computed tomography (CT) in diagnosis
 and detection of pediatric stroke. Head CT without contrast is the study of choice for
 identifying acute hemorrhage but may be normal in the cases of ischemic stroke in the first
 12 to 24 hours after the event .( Alberts MJ et al., 2011)& (Elbers J et al.,2015) Therefore,
 MRI is a more sensitive modality for stroke including AIS, vascular malformations, and
 central nervous system inflammatory changes. Non contrast CT used for the detection of brain
 ischemia is more sensitive after the initial 24 hours.
Inclusion Criteria:

 -  - Infant and Children around age of (1month to 18years old) of both sexes were
 diagnosed as stroke (hemorrhagic or ischemic) by CT or MRI.

 Exclusion Criteria:

 -  - Neonates (less than one month)

 -  Stroke caused by trauma

 -  Patient refusal to participate the research