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Presentation of Acute Childhood Stroke in a Tertiary Pediatric Emergency Department

Yock-Corrales, Adriana MD, MSc*†; Varela-Bulgarelli, Flory MD; Barboza, Cary MD; Gutierrez-Mata, Alfonso MD†§; Mackay, Mark T. MBBS, FRACP‖¶#**; Babl, Franz MD, MPH, FRACP, FAAP¶#††

doi: 10.1097/PEC.0000000000000918
Original Articles
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Objectives The aim was to describe clinical presentation, management, and outcomes of stroke in a tertiary emergency department (ED) of a developing country.

Methodology Retrospective case series of patients aged 1 month to 18 years presenting to an ED with radiological confirmed acute stroke during a 7-year period were studied.

Results Ninety-five patients were identified. Twenty-five patients were excluded because of incomplete records (8) or not presenting via ED (17). Thirty-four (48.5%) were diagnosed with hemorrhagic stroke (HS), 30 (42.8%) with arterial ischemic stroke (AIS), and 6 (8.5%) with sinus venous thrombosis (SVT). Mean age was 5.3 years, and 55.3% were male. The median time from onset of symptoms to ED presentation was 24 hours (mean, 55 hours; interquartile range [IQR], 14–72) for AIS, 24 hours (mean, 46.9 hours; IQR, 9–48) for HS, and 120 hours (mean,112 hours; IQR, 72–168) for SVT. Congenital cardiac disease was the most common risk factor (9%). For AIS, the most common symptoms were focal numbness 56.6% (95% confidence interval [CI], 37.8%–75.4%), focal weakness 56.6% (95% CI, 37.8%–75.4%), and seizures 50% (95% CI, 31%–68.8%). For HS, the most common symptoms were headache 64.7% (95% CI, 47.7%–81.6%), vomiting 79.4 (95% CI, 65–93.7), and altered mental status 64.7% (95% CI, 47.7–81.6). Computed tomography scan was done in 100% of the patients and magnetic resonance imaging in 54%. Twenty-five (36%) patients were admitted to intensive care unit and required intubation. Long-term deficit was identified in 24 (36%) patients based on medium-term follow-up.

Conclusions The spectrum of stroke in a developing country was similar to published series from developed countries in terms of final diagnosis, risk factors, and delay to ED presentation, neuroimaging, and long-term neurodeficits. No tropical diseases were identified as risk factors.

From the *Emergency Department, Hospital Nacional de Niños,

University of Costa Rica,

Cardiology Department, and

§Neurology Department, Hospital Nacional de Niños, San José, Costa Rica;

Neurology Department, Royal Children's Hospital,

University of Melbourne,

#Murdoch Children's Research Institute, Melbourne, Victoria;

**Florey Institute of Neurosciences and Mental Health, Parkville, and

††Emergency Department, Royal Children's Hospital Melbourne, Victoria, Australia.

Disclosure: The authors declare no conflict of interest.

Presented at International Conference of Emergency Medicine (ICEM) 2014 meeting, June 2014. Hong Kong.

Reprints: Adriana Yock-Corrales, MD, MSc, Servicio de Emergencias Pediátricas, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Avenida Paseo Colón, PO Box 1654-1000, San José, Costa Rica (e-mail: adriyock@gmail.com).

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