Pediatric stroke and predictors of neurological outcome: A prospective observational study

Objectives Stroke in children is a significant cause of mortality and neurological disability in the long term. There is a paucity of data regarding the factors that affect neurological outcomes in childhood stroke patients. Materials and Methods This prospective cohort study aimed to explore the clinical profile of children with stroke at a tertiary care hospital in western India and the factors responsible for neurological disability. The study population consisted of children up to 18 years of age. Clinical, radiological, and laboratory data at the time of stroke onset were collected. Neurological disability was assessed through the pediatric stroke outcome measure (PSOM) at the time of stroke and 6 months post-stroke. The PSOM is a validated structured neurological tool for outcome assessment in pediatric stroke patients. Results Fifty-five children were enrolled in the study over 2 years. Arterial-ischemic stroke was the most common (75%) type of stroke, followed by hemorrhagic stroke (13%). Overall, mineralizing angiopathy was the most common cause of stroke. The factors associated with higher PSOM scores at the time of stroke were age between 2 and 5 years, central nervous system tuberculosis, bilateral hemispheric involvement, impaired consciousness, and the presence of anemia. Forty-four children completed follow-up at 6 months after stroke onset. The factors associated with significantly higher PSOM scores were age between 2 and 5 years, central nervous system tuberculosis, and impaired consciousness at presentation ( P < 0.05). The mean PSOM score was lowest at onset (1.53, standard deviation [SD] = 1.17) and 6 months post-stroke (0.5, SD = 0.42) in children with mineralizing angiopathy. Conclusion At 6 months post-stroke, children who present with stroke onset between 2 and 5 years of age, impaired consciousness at the time of stroke, and neurotuberculosis have slower recovery with greater disability. Children with mineralizing angiopathy have relatively better recovery with fewer disabilities, as assessed by the PSOM.