ASSESSING THE ETIOLOGICAL SPECTRUM AND CLINICAL PRESENTATION OF ISCHEMIC STROKE IN INDIAN PEDIATRIC SUBJECTS

Abstract

Background: Ischemic stroke in pediatric subjects is a rare clinical condition that contribute to a significant cause of
long-term neurological mortality and morbidity. Etiology of ischemic stroke in children is significantly different from
adults and are associated with prothrombotic states, arteriopathies, and infections particularly in developing nations as
India.
Aim: The present study was aimed to assess the etiological spectrum and clinical presentation of ischemic stroke in Indian
pediatric subjects.
Methods: The present study assessed 60 child subjects in the age range of 1month to 18 years with confirmed diagnosis
of ischemic stroke within the defined study period. Etiology, imaging findings, and clinical features were assessed in all
the study subjects. For etiology, classification was done following Childhood AIS Standardized Classification and
Diagnostic Evaluation system. Severity of stroke was assessed using Pediatric National Institute of Health Stroke Scale.
Results: There were higher number of males in the study. Most common presenting symptom was hemiparesis followed
by seizures and facial nerve palsy as seen in 93%, 33%, and 30% subjects respectively. MRI reported involvement of
anterior circulation in 97% cases that commonly affected middle cerebral artery in 73% subjects. Most common etiology
was post-infectious arteriopathy with other etiologies being multifactorial/undetermined, cardioembolic causes, bilateral
arteriopathies, and metabolic/prothrombotic disorders. Majority of cases had moderate severity of stroke at presentation.
Conclusion: The present study concludes that infections, primarily tuberculosis is an emerging cause of ischemic stroke
in children. In majority of subjects, anterior circulation stroke was commonly seen with most common symptom being
hemiparesis. Comprehensive etiological work, timely neuroimaging, and high suspicion index are vital for prevention of
long-term complications and early diagnosis.