Analysis Of Clinical Features Of Pediatric Arterial Ischemic Stroke

Objective: To analyze the risk factors,clinical manifestations,neuroimaging and EEG features of pediatric arterial ischemic stroke.Methods: Retrospective analysis of pediatric arterial ischemic stroke hospitalized into the Children’s Hospital of Chongqing Medical University from January 2011 to February 2021.Results: 1.217 cases were enrolled,114 cases(52.5%)were boys,103cases(47.5%)were girls.The age ranged from 30 days and 16 years old,the median age were 3.5(1.1-7.0)years old.Most of the children suffered before13 years old,and the peak morbidity period was the infancy.The time from onset to treatment was 2.0(1.0-5.0)days,and the hospitalization time was10.0(8.0-14.0)days.2.Among the 217 cases,no identifiable risk factors was present in 39cases(18.0%),the remaining children had more than one risk factors,including: 108 cases(49.8%)of acute head and neck disorders,45 cases(20.7%)of arteriopathies,30 cases(13.8%)of acute systemic disorders,29 cases(13.4%)of cardiac disorders,24 cases(11.1%)of chronic head and neck disorders,16 cases(7.4%)of chronic systemic disorders,8 cases(3.7%)of prothrombotic states.Besides,65 cases(30%)of children had a history of respiratory tract infection within 1 month before the disease.3.145 cases(66.8%)onset with focal signs,38 cases(17.5%)with diffuse signs,and 24 cases(11.2%)with seizures.In the pathogenesis with pediatric arterial ischemic stroke,the main clinical manifestations were followed by 189 cases(87.1%)of hemiplegia 134 cases(61.8%)of facial paralysis,68 cases(31.3%)of language impairment,45 cases(20.7%)of seizures,38 cases(17.5%)of disturbance of consciousness,36 cases(16.6%)of nausea or vomiting and 35 cases(16.1%)of headache.4.84 cases(38.7%)of neuroimaging were completed within 24 hours.188 cases(86.6%)finished vascular imaging,including 142 cases of artery abnormalities.Involvement of the left were 119 cases(63.3%),while the right were 84 cases(44.7%),and the bilateral were 14 cases(6.9%).The sequence of lesions commonly affected were: 156 cases(71.9%)of the basal ganglia,66 cases(30.4%)of the frontal lobe,62 cases(28.6%)of the parietal lobe,and 48 cases(22.1%)of temporal lobe.The arteries commonly involved were: 109 cases(76.8%)of the middle cerebral artery,45 cases(31.7%)of the anterior cerebral artery,39 cases(27.5%)of the internal carotid artery,27 cases(19.0 %)of posterior communicating artery and 26cases(18.3%)of posterior cerebral artery.5.140 cases(64.5%)had performed EEG.EEG showed abnormal in 77 cases,boundaries in 15 cases,normal in 48 cases.Among the abnormal EEG cases,45 cases in abnormal background activities of EEG,21 cases in epileptiform discharges,7 cases in abnormal background activities with epileptiform discharges,and 5 cases in abnormal background activities with suspected epileptic discharge.Among the 28 cases of epileptiform discharges,8 cases had clinical seizures,while 20 cases not.Conclusion: Childhood AIS mainly occurs in children under 3 years old.Acute head and neck trauma and arterial disease were the most common risk factors in childhood AIS.Focal neurological deficits were the main onset symptoms and clinical manifestations of childhood AIS,however,infants are also commonly onset of seizures.As age grows,there were much more children onset with diffuse signs(like dizziness and headache).These all can bring difficulties to early recognition of childhood AIS.Therefore,to avoid delaying in diagnosis and treatment,and improving prognosis,brain magnetic resonance imaging and(or)vascular imaging should be perfected as soon as possible.In addition,to avoid missing the subclinical epileptiform discharge children,EEG are routinely recommended to complete.