Journal of the Korean Child Neurology Society (대한소아신경학회지)

The Korean Child Neurology Society (대한소아신경학회)
권호 표지
DOI QR코드

DOI QR Code

Neurological Outcome of Ischemic Stroke in Children: a Single Center Study

소아 허혈성 뇌졸중의 신경학적 예후: 단일 기관 연구

  • Hong, Seung Hee (Department of Pediatrics, Chonnam National University Medical School) ;
  • Chang, Seong Hwan (Department of Pediatrics, Chonnam National University Medical School) ;
  • Jung, Eui Seok (Department of Pediatrics, Chonnam National University Medical School) ;
  • Kim, Young Ok (Department of Pediatrics, Chonnam National University Medical School) ;
  • Choi, Young Youn (Department of Pediatrics, Chonnam National University Medical School) ;
  • Woo, Young Jong (Department of Pediatrics, Chonnam National University Medical School)
  • 홍승희 (전남대학교 의과대학 소아과학교실) ;
  • 장성환 (전남대학교 의과대학 소아과학교실) ;
  • 정의석 (전남대학교 의과대학 소아과학교실) ;
  • 김영옥 (전남대학교 의과대학 소아과학교실) ;
  • 최영륜 (전남대학교 의과대학 소아과학교실) ;
  • 우영종 (전남대학교 의과대학 소아과학교실)
  • Received : 2018.07.25
  • Accepted : 2018.09.02
  • Published : 2018.09.30
⟨ Previous Next ⟩

Abstract

Purpose: Ischemic stroke is rarely seen in children, but it could cause mortality and result in developmental disabilities such as motor paralysis, cognitive dysfunction, and epilepsy. In this study, the neurological outcomes of ischemic stroke in children were reviewed and the factors associated with the neurological outcomes were to be analyzed. Methods: Medical records of patients younger than 15 years of age who were newly diagnosed with ischemic stroke between January 2006 and December 2016 in Chonnam National University Hospital were reviewed. Results: This study consisted of 38 patients with ischemic stroke (male/female= 18/20, mean age=6 years 1 month ${\pm}4years$ 8 months). Neurological outcomes assessment was done at least 1 year after the onset of ischemic stroke. 10 patients (26.3%) had no neurological impairments. Motor paralysis was noted in 22 (57.9%), cognitive dysfunction was in 9 (23.7%), and epilepsy in 20 (52.6%). Among the possible risk factors for neurological impairments (age, sex, early seizures, characteristics of the infarcted lesions, abnormal electroencephalogram (EEG) findings), abnormalities on EEG findings were significantly associated with cognitive dysfunction (P=0.026) and the occurrence of early seizures with epilepsy (P=0.000). Conclusion: Neurological impairments were remained in 73.7% of children one year after ischemic stroke. Cognitive dysfunction was associated with abnormalities on EEG findings within 2 weeks after the onset of ischemic stroke and epilepsy with the occurrence of early seizures.

목적: 허혈성 뇌졸중은 소아에서 드물게 발생하는 질환이지만 심각하게는 사망을 초래하고 운동마비, 인지장애, 뇌전증 등과 같은 발달장애를 남길 수 있어 임상적 중요성이 강조되고 있다. 본 연구에서는 소아 허혈성 뇌졸중의 신경학적 예후를 조사하였으며 예후와 연관성이 있는 요인을 찾아 보고자 하였다. 방법: 2006년 1월부터 2016년 12월까지 전남대학교병원 소아청소년과에서 허혈성 뇌졸중으로 진단 받았던 15세 미만 환자들을 대상으로 의무기록을 후향적으로 조사하였다. 결과: 대상 환자 총 38명 중 남자가 18명(47.4%), 여자가 20명(52.6%)이었고 평균 연령은 6세 1개월${\pm}4$세 8개월이었다. 특발성 허혈성 뇌졸중이 14명(36.8%)으로 가장 많았고 허혈성 뇌졸중의 원인으로 모야모야병, 수막염, 급성 심근염, 급성 림프구성 백혈병, 패혈증, 외상 등이 있었다. 허혈성 뇌졸중 발병 후 2주 이내 초기 경련이 19명(50.0%)에서 나타났고 이 중 14명(73.7%)은 부분 경련을, 5명(26.3%)은 전신 경련을 보였다. 뇌자기공명영상 검사에서 15명(39.5%)은 좌뇌에, 16명(42.1%)은 우뇌에 병변을 보였으며 26명(68.4%)에서 하나의 병변이, 12명(31.6%)에서 여러 개의 병변이 관찰되었다. 허혈성 뇌졸중 발병 후 2주 이내에 33명(86.8%)에서 뇌파 검사를 시행하였고 이 중 21명(63.6%)에서 이상 뇌파가 관찰되었다. 1년 이상 추적 관찰하여 신경학적 예후를 조사하였고 신경학적 장애가 남지 않은 환자는 10명(26.3%)이었으며 운동마비가 22명(57.9%), 인지장애가 9명(23.7%), 뇌전증이 20명(52.6%)에서 나타났다. 연령, 성별, 초기 경련, 병변의 특성, 이상 뇌파 중 각 신경학적 장애와 연관성이 있는 요인을 분석하여 보았을 때 인지장애와 연관성이 있는 요인으로는 이상 뇌파가 있었고(P 값=0.026) 뇌전증과 연관성이 있는 요인으로는 초기 경련이 있었다(P 값=0.000). 결론: 소아 허혈성 뇌졸중 발병 1년 후 73.7%에서 신경학적 장애가 남았다. 인지장애는 허혈성 뇌졸중 발병 후 2주 이내에 보였던 이상 뇌파와 연관성이 있었으며 뇌전증은 초기 경련의 발생과 연관성이 있었다.

Keywords

References

  1. Kirton A, deVeber G. Paediatric stroke: pressing issues and promising directions. Lancet Neurol 2015;14:92-102. https://doi.org/10.1016/S1474-4422(14)70227-3
  2. Lynch JK, Hirtz DG, DeVeber G, Nelson KB. Report of the national institute of neurological disorders and stroke workshop on perinatal and childhood stroke. Pediatrics 2002;109:116-23. https://doi.org/10.1542/peds.109.1.116
  3. Tsze DS, Valente JH. Pediatric stroke: a review. Emerg Med Int 2011;2011:734506.
  4. deVeber GA, MacGregor D, Curtis R, Mayank S. Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol 2000;15:316-24. https://doi.org/10.1177/088307380001500508
  5. Lanthier S, Carmant L, David M, Larbrisseau A, de Veber G. Stroke in children: the coexistence of multiple risk factors predicts poor outcome. Neurology 2000;54: 371-8. https://doi.org/10.1212/WNL.54.2.371
  6. Ganesan V, Hogan A, Shack N, Gordon A, Isaacs E, Kirkham FJ. Outcome after ischaemic stroke in childhood. Dev Med Child Neurol 2000;42:455-61. https://doi.org/10.1017/S0012162200000852
  7. Sreenan C, Bhargava R, Robertson CM. Cerebral infarction in the term newborn: clinical presentation and long-term outcome. J Pediatr 2000;137:351-5. https://doi.org/10.1067/mpd.2000.107845
  8. Elbers J, deVeber G, Pontigon AM, Moharir M. Long-term outcomes of pediatric ischemic stroke in adulthood. J Child Neurol 2014;29:782-8. https://doi.org/10.1177/0883073813484358
  9. Yi JS, Kim YO, Kim BJ, Kang JS, Woo YJ, Kim JH. Risk factors of epilepsy after stroke in children. J Korean Child Neurol Soc 2002;10:103-10.
  10. Leys D, Bandu L, Henon H, Lucas C, Mounier-Vehier F, Rondepierre P, et al. Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke. Neurology 2002;59:26-33. https://doi.org/10.1212/WNL.59.1.26
  11. Olsen TS, Hogenhaven H, Thage O. Epilepsy after stroke. Neurology 1987;37:1209-11. https://doi.org/10.1212/WNL.37.7.1209
  12. Goldenberg NA, Bernard TJ, Fullerton HJ, Gordon A, deVeber G. Antithrombotic treatments, outcomes, and prognostic factors in acute childhood-onset arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol 2009;8:1120-7. https://doi.org/10.1016/S1474-4422(09)70241-8
  13. Choi YJ, Kang JH, Kim SH. Ischemic stroke in children. J Korean Child Neurol Soc 2002;10: 262-72.
  14. Kelly-Hayes M, Beiser A, Kase CS, Scaramucci A, D'Agostino RB, Wolf PA. The influence of gender and age on disability following ischemic stroke: the Framingham study. J Stroke Cerebrovasc Dis 2003;12:119-26. https://doi.org/10.1016/S1052-3057(03)00042-9
  15. Mackay MT, Wiznitzer M, Benedict SL, Lee KJ, Deveber GA, Ganesan V. Arterial ischemic stroke risk factors: the international pediatric stroke study. Ann Neurol 2011;69:130-40. https://doi.org/10.1002/ana.22224
  16. Ikezaki K, Han DH, Kawano T, Kinukawa N, Fukui M. A clinical comparison of definite moyamoya disease between South Korea and Japan. Stroke 1997;28:2513-7. https://doi.org/10.1161/01.STR.28.12.2513
  17. Hervey-Jumper SL, Annich GM, Yancon AR, Garton HJ, Muraszko KM, Maher CO. Neurological complications of extracorporeal membrane oxygenation in children. J Neurosurg Pediatr 2011;7:338-44.
  18. De Stefano V, Sora F, Rossi E, Chiusolo P, Laurenti L, Fianchi L, et al. The risk of thrombosis in patients with acute leukemia: occurrence of thrombosis at diagnosis and during treatment. J Thromb Haemost 2005;3:1985-92. https://doi.org/10.1111/j.1538-7836.2005.01467.x
  19. Chung NY, Lee JW, Lee DH, Cho B, Choi BJ, Kim YH, et al. The clinical manifestations and the risk factors of seizures after hematopoietic stem cell transplantation in children. J Korean Child Neurol Soc 2006;14:266-75.
  20. deVeber G, Monagle P, Chan A, MacGregor D, Curtis R, Lee S, et al. Prothrombotic disorders in infants and children with cerebral thromboembolism. Arch Neurol 1998;55:1539-43. https://doi.org/10.1001/archneur.55.12.1539
  21. Fox CK, Hills NK, Vinson DR, Numis AL, Dicker RA, Sidney S, et al. Population-based study of ischemic stroke risk after trauma in children and young adults. Neurology 2017;89:2310-6. https://doi.org/10.1212/WNL.0000000000004708
  22. Lee YK, Lee CW, Huang MY, Hsu CY, Su YC. Increased risk of ischemic stroke in patients with mild traumatic brain injury: a nationwide cohort study. Scand J Trauma Resusc Emerg Med 2014;22:66. https://doi.org/10.1186/s13049-014-0066-y
  23. Boden-Albala B, Sacco RL, Lee HS, Grahame-Clarke C, Rundek T, Elkind MV, et al. Metabolic syndrome and ischemic stroke risk: Northern Manhattan Study. Stroke 2008;39:30-5. https://doi.org/10.1161/STROKEAHA.107.496588
  24. Mallick AA, Ganesan V, Kirkham FJ, Fallon P, Hedderly T, McShane T, et al. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective populationbased study. Lancet Neurol 2014;13:35-43. https://doi.org/10.1016/S1474-4422(13)70290-4
  25. Fish DR, Miller DH, Roberts RC, Blackie JD, Gilliatt RW. The natural history of late-onset epilepsy secondary to vascular disease. Acta Neurol Scand 1989;80:524-6.
  26. Arditi H, Feldman R, Hammerman C, Eidelman AI. Cerebral blood flow velocity asymmetry, neurobehavioral maturation, and the cognitive development of premature infants across the first two years. J Dev Behav Pediatr 2007;28:362-8. https://doi.org/10.1097/DBP.0b013e318114315d
  27. Naess H, Waje-Andreassen U, Thomassen L, Myhr KM. High incidence of infarction in the left cerebral hemisphere among young adults. J Stroke Cerebrovasc Dis 2006;15:241-4. https://doi.org/10.1016/j.jstrokecerebrovasdis.2006.06.003
  28. Hedna VS, Bodhit AN, Ansari S, Falchook AD, Stead L, Heilman KM, et al. Hemispheric differences in ischemic stroke: is lefthemisphere stroke more common? J Clin Neurol 2013;9:97-102. https://doi.org/10.3988/jcn.2013.9.2.97
  29. Ng YS, Stein J, Ning M, Black-Schaffer RM. Comparison of clinical characteristics and functional outcomes of ischemic stroke in different vascular territories. Stroke 2007;38:2309-14. https://doi.org/10.1161/STROKEAHA.106.475483
  30. Wolf ME, Ebert AD, Chatzikonstantinou A. The use of routine EEG in acute ischemic stroke patients without seizures: generalized but not focal EEG pathology is associated with clinical deterioration. Int J Neurosci 2017;127:421-6. https://doi.org/10.1080/00207454.2016.1189913