PREDICTORS OF OUTCOME OF STROKE IN INFANTS AND CHILDREN BASED ON CLINICAL-DATA AND RADIOLOGIC CORRELATES

Outcome predictors were analyzed in 45 infants and children with cereb rovascular disorders (CVD), based on clinical features and radiologica l correlates. The clinical features at presentation could be categoriz ed into three major groups: (1) generalized: alteration of consciousne ss with or without seizures-24 patients (54%); (2) focal: acute hemipl egia,or monoplegia with or without focal seizures-18 patients (40%); ( 3) cerebellar disturbances-3 patients (6%). The underlying etiology wa s detected in 80% of children. Thirty-seven patients (82%) survived th e initial debilitating event, of whom 11 (29.7%) recovered completely and the rest had either motor or cognitive handicaps during an average follow-up period of 4.2 years (range 1.5-11 years). A head CT perform ed in all children revealed ischemic infarction in 29 patients (64.4%) , while the others had hemorrhagic infarction. Of those with an initia l generalized neurological presentation, as many as 50% had multi-foca l lesions on CT. All children with focal neurological findings had a s olitary localized lesion on CT, mainly in the distribution of the midd le cerebral artery. Statistical analysis for outcome prediction showed that the following variables were associated with increased risk of i mmediate death: (1) hemorrhagic infarction demonstrated by brain CT (p = 0.031); (2) patients who presented with a generalized neurological disorder, namely alteration of consciousness, with or without seizures (p = 0.036). No other clinical or laboratory variables were predictiv e of imminent death, motor or cognitive handicaps. These may therefore serve as outcome predictors of stroke in the pediatric age group.