Etiology of Pediatric Stroke at a Tertiary Care Hospital of Southern Punjab

Ali  Tariq; Fayyaz  Hussain; Ikram Ur  Rahman; Sohail  Safdar

doi:10.54112/bcsrj.v6i6.2096

Authors

Ali Tariq Department of Neurology, The Children's Hospital and The Institute of Child Health, Multan, Pakistan
Fayyaz Hussain Sindh Institute of Urology & Transplantation Karachi, Pakistan
Ikram Ur Rahman Department of Neurology, The Children's Hospital and The Institute of Child Health, Multan, Pakistan
Sohail Safdar Nishtar Medical University Multan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.2096

Keywords:

Etiology; Hemorrhagic Stroke; Ischemic Stroke; Pediatric Stroke

Abstract

Pediatric stroke is an important cause of childhood morbidity with diverse etiological factors that vary across regions. Early identification of underlying causes is essential for timely management and improved outcomes. Objective: To determine the pattern and burden of etiological factors of pediatric stroke at a tertiary care hospital in Southern Punjab. Methods: This descriptive case series was conducted in the Department of Neurology, The Children's Hospital and Institute of the Child Health, Multan, and included 110 children diagnosed with stroke using a non-probability purposive sampling technique. After enrollment, detailed history-taking and thorough clinical examination were performed, followed by appropriate neurological and laboratory investigations to ascertain the aetiology of the stroke. Demographic variables, stroke type, and etiological factors were recorded. Data were analysed using SPSS version 23. Mean and standard deviation were calculated for continuous variables such as age and weight. At the same time, frequencies and percentages were computed for categorical variables, including gender, age groups, residential status, stroke type, and etiological factors. Results: Out of 110 children, 65.5% were males and 34.5% were females, with a mean age of 5.85 ± 2.64 years. Most patients (72.7%) were aged six years or younger. The majority lived in urban areas (70.0%) and were from middle-income families (73.6%). Ischemic stroke was observed in 83.6% of cases, whereas 16.4% had hemorrhagic stroke. The mean body weight was 14.93 ± 4.87 kg, and obesity was noted in 13.6% of children. Infective causes were the most frequent etiological factor (50.9%), followed by vascular (26.4%), haematological (12.7%), cardiac (4.5%), and unknown causes (5.5%). Conclusion: Intracranial infections were the leading etiological factor of pediatric stroke in this setting, followed by vascular and haematological causes. Ischemic stroke was more prevalent than hemorrhagic stroke. Awareness of these patterns may facilitate early Diagnosis, targeted management, and improved prognosis in children with stroke.

Downloads

Download data is not yet available.

References

Ibrahim S., Anjum M., & Soomro S. Pediatric arterial ischemic stroke; risk factors, clinical presentation and short-term outcome of patients presenting at a tertiary care hospital. The Professional Medical Journal 2024; 31(05):789-794. https://doi.org/10.29309/tpmj/2024.31.05.8053

Pizzatto R., Resende L., Lôbo C., Neves Y., Paz J., Alves C.et al.. Arteriopathy in pediatric stroke: an underestimated clinical entity. Arquivos De Neuro-Psiquiatria 2021; 79(4):321-333. https://doi.org/10.1590/0004-282x-anp-2020-0105

Babeer G., Omran D., Bawahab N., Hussain R., Muthaffar O., Alzahrani F.et al.. Prevalence and risk factors of stroke among children with sickle cell disease: a retrospective study at a tertiary care centre. Cureus 2023. https://doi.org/10.7759/cureus.41960

Larbi M., Mangour W., Saba I., Naqeb D., Faisal Z., Omar S., et al Ischemic and non-ischemic stroke in young adults – a look at risk factors and outcome in a developing country. Cureus 2021. https://doi.org/10.7759/cureus.17079

Moiz B., Ukrani R., Arif A., Akbar I., Sadiq M., & Altaf S. Case study of pediatric cerebral sinus venous thrombosis centre of a low-middle-income country. Clinical and Applied Thrombosis/Hemostasis 2021; 27. https://doi.org/10.1177/10760296211022847

Bykov Y., Obedin A., Fischer V., Volkov E., Zinchenko O., Muravyova A.et al.. Acute cerebrovascular accident in children: clinical presentation and intensive care management. Avicenna Bulletin 2024;26(3):427-438. https://doi.org/10.25005/2074-0581-2024-26-3-427-438

Bano S., Farooq M., Nazir S., Aslam A., Tariq M., Javed M.et al.. Structural imaging characteristics, clinical features and risk factors of cerebral venous sinus thrombosis: a prospective cross-sectional analysis from a tertiary care hospital in pakistan. Diagnostics 2021;11(6):958. https://doi.org/10.3390/diagnostics11060958

Khan R., Nawaz M., Khan S., Raza H., Nazir T., Anwar M.et al.. Prevalence of dyslipidemia in ischemic stroke patients: a single-centre prospective study from pakistan. Cureus 2022. https://doi.org/10.7759/cureus.25880

Taimuri B., Malik A., Muhammad R., & Javed M. Frequency of hyperlipidemia in patients with ischemic stroke visiting a tertiary care hospital in Karachi. Pakistan Journal of Neurological Sciences 2023;18(02). https://doi.org/10.56310/pjns.v18i02.265

Fatima N., Salman M., Hashim H., Ambreen A., Sayed T., & Waheed S. Prevalence of newly diagnosed hypertension in stroke patients presented to tertiary care hospitals in Rawalpindi. PJMHS 2022;16(9):826-828. https://doi.org/10.53350/pjmhs22169826

Saad M., Mumtaz A., Ahmed S., Hashim H., Malik A., & Jang F. Association of homocysteine and ischemic stroke in Pakistani population: a case control study. Biological and Clinical Sciences Research Journal 2023;2023(1):258. https://doi.org/10.54112/bcsrj.v2023i1.258

Khan R., Waqas A., Mustehsan Z., Khan A., Sikander S., Ahmad I.et al.. Predictors of prenatal depression: a cross-sectional study in rural pakistan. Frontiers in Psychiatry 2021;12. https://doi.org/10.3389/fpsyt.2021.584287

Hassan J., Usman N., Salman M., Ali A., Shaukat M., Khan H.et al.. Assessing the validity of Society of Thoracic Surgeons (STS) score in predicting stroke risk in cardiothoracic surgery: insights from a tertiary hospital in pakistan. 2024. https://doi.org/10.21203/rs.3.rs-5334070/v1

Luqman S., Mumtaz A., Kulsoom S., Ahmed S., Malik A., & HAIDER S. Predictors of mortality and poor functional outcome in patients with acute stroke admitted to a tertiary care hospital in pakistan. Biological and Clinical Sciences Research Journal 2023;2023(1):281. https://doi.org/10.54112/bcsrj.v2023i1.281

Woods G., Miller A., Mosha M., Male C., Verma A., Kucine N.et al.. Clinical characteristics, treatment, and outcomes of provoked acute cerebral sinovenous thrombosis in patients <21 years old: findings from the kids-dott multinational trial. Research and Practice in Thrombosis and Haemostasis 2024;8(7):102605. https://doi.org/10.1016/j.rpth.2024.102605

Miyamoto K., Takayasu H., Maeda A., Sasaki J., & Hayashi M. Stroke in a toddler after minor head injury: an emerging diagnostic challenge. Cureus 2023. https://doi.org/10.7759/cureus.35479

Pangprasertkul S., Borisoot W., Buawangpong N., Sirikul W., Wiwattanadittakul N., Katanyuwong K.et al.. Comparison of arterial ischemic and hemorrhagic pediatric stroke in aetiology, risk factors, clinical manifestations, and prognosis. Pediatric Emergency Care 2022;38(9):e1569-e1573. https://doi.org/10.1097/pec.0000000000002614

Alloush R., Eldin N., El-Khawas H., Shatla R., Nada M., Mohammed M.et al.. Pediatric vs. adult stroke: comparative study in a tertiary referral hospital, Cairo, Egypt. The Egyptian Journal of Neurology, Psychiatry, and Neurosurgery 2022;58(1). https://doi.org/10.1186/s41983-022-00514-5

Robertson D., Wright M., Ostrander B., & Tani L. Child neurology: case report of lambl excrescences in a pediatric patient with multifocal strokes. Neurology 2022;99(2):73-76. https://doi.org/10.1212/wnl.0000000000200747

Deng Y., Liu G., Zhang G., Xu J., Chunmei Y., Wang L.et al.. Childhood strokes in China: describing clinical characteristics, risk factors and performance indicators: a case-series study. Stroke and Vascular Neurology 2021;7(2):e001062. https://doi.org/10.1136/svn-2021-001062

Alkhafaji Y., Al-Nahhas O., Alkheder K., & Alkoteesh J. When hearts and minds collide: a case report of left ventricle noncompaction syndrome as a precursor to acute ischemic stroke in a 15-year-old, along with a literature review. Cureus 2024. https://doi.org/10.7759/cureus.54168

Farias‐Moeller R., Siddiqui S., Orr M., & Mondok L. Too much of a good thing? Cerebral sinovenous thrombosis due to excessive milk intake associated with anaemia. Journal of Child Neurology 2020;35(9):585-590. https://doi.org/10.1177/0883073820923807

Ni S., Che S., & Cai J. Extensive and progressive cerebral infarction associated with Mycoplasma pneumoniae infection. A case report and literature review. 2024. https://doi.org/10.21203/rs.3.rs-4130584/v1

Belani P., Schefflein J., Kihira S., Rigney B., Delman B., Mahmoudi K., et al COVID-19 is an independent risk factor for acute ischemic stroke. American Journal of Neuroradiology 2020;41(8):1361-1364. https://doi.org/10.3174/ajnr.a6650

Tabarki B., Hakami W., Alkhuraish N., Graies-Tlili K., Nashabat M., & Alfadhel M. Inherited metabolic causes of stroke in children: mechanisms, types, and management. Frontiers in Neurology 2021;12. https://doi.org/10.3389/fneur.2021.633119

Pramanasari I.. Dyke-davidoff-masson syndrome (DDMS) in an adult: a rare case in a rural area. Aksona 2023;3(1):26-30. https://doi.org/10.20473/aksona.v3i1.38419

Shih E., Beslow L., Natarajan S., Falkensammer C., Messé S., & Ichord R. Prevalence of patent foramen ovale in a cohort of children with cryptogenic ischemic stroke. Neurology 2021;97(21). https://doi.org/10.1212/wnl.0000000000012892

Sasidharan S. and Krishnasree K. Transient focal cerebral arteriopathy of childhood following dengue fever. Journal of Postgraduate Medicine 2020;66(3):172-173. https://doi.org/10.4103/jpgm.jpgm_524_19.