CEREBRAL INFARCTION IN PEDIATRIC-PATIENTS - A REVIEW OF 60 CASES

Cerebral infarction is rare during childhood and its cause remains unc lear in 20 to 50% of cases. Clinical features, causes, and outcomes we re studied in 60 cases seen over a 15-year period. Sudden-onset hemipl egia (80%), dysphasia (30%), headache (25%), vomiting (25%), altered c onsciousness (12%), and seizures (12%) were the main presenting sympto ms. The stroke occurred during or in the wake of an infection in one f ourth of cases. A cause was identified in 35% of cases. Causes were em bolism due to a heart disorder in 7 cases, cerebral vasculitis in thre e cases, sickle cell anemia in three cases, cerebral radiation therapy in two cases, arterial dissection in two cases, Melas syndrome in two cases, and sulfite oxidase deficiency in one case. Half the patients underwent cerebral angiography, which was abnormal in half the cases; abnormalities included arterial dissection, stenosis or occlusion of a n artery, and diffuse slowing of distal blood flow. Thirteen per cent of patients has a second cerebral infarction and 11.5% died. Two-third s of patients had residual neurologic abnormalities. The infarction oc curred in the area of the basal ganglia in 35% of cases; precipitating factors were often identified in these patients, whereas a cause was not, and the prognosis was relatively good, with only one patient havi ng a recurrence and 40% having moderate residual abnormalities consist ing mainly in delayed dystonia.