Long-term Outcome in Children with Arterial Ischemic Stroke: A North Indian Center-based Study

Objective: To describe the long-term outcome in children with acute ischemic stroke (AIS) from a tertiary-care center. Materials and Methods: Prospective, observational study of children diagnosed with AIS between the ages of six months and 12 years and who completed two to five years of follow-up. Results: Forty-nine children (35 boys, 14 girls) were included. The mean age at onset of stroke was 35.6 ±31.5 months (6-108 months). A majority of children had presented with hemiparesis (93.8%). Risk factors were identified in 65.4% of cases. Moyamoya vasculopathy (28%), iron-deficiency anemia (24.4%), and trauma (12.2%) were the most common risk factors. The majority of infarcts were cortical (32.6%), followed by combined cortical and subcortical (30.6%), and isolated subcortical (26.5%). At follow-up, recurrent stroke (24.4%), residual epilepsy (24.4%), and motor disability requiring support for ambulation (6%) were noted. The mean general developmental score (GDS) was 71.2 } 18.7. Global developmental delay in 46.9% and delayed social intelligence in 22.4% was noted. On subset analysis, children had physical (42.9%), cognitive (34.7%), communication (30.6%), adaptive-behavior (26.5%), and social-emotional (22.4%) delay. Predictors of good cognitive outcome were younger age at onset (OR 0.964, P = 0.006), isolated subcortical infarcts (OR 26.386, P = 0.028), and absence of seizures at presentation (OR 0.197, P = 0.044). Predictors of poor social quotient were seizures at onset (OR 0.049, P = 0.012) and recurrent stroke (OR 0.055, P = 0.012). Conclusion: Neurodevelopmental problems and epilepsy occur in a significant proportion of children with AIS in the long term. Good outcomes are predicted by the younger age of onset, subcortical infarcts, absence of seizures, and absence of recurrence of stroke.