Association Between Prolonged Seizures and Malignant Middle Cerebral Artery Infarction in Children With Acute Ischemic Stroke - 29/10/16

Doi : 10.1016/j.pediatrneurol.2016.08.015

Andrea Andrade, MD ^a,^⁎,^{^{1
These authors were equally responsible for the work described in this paper.},}^{^{2
Present address: Department of Paediatrics, Neurology Section, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.}} , Sandra Bigi, MD ^a,^{^{1
These authors were equally responsible for the work described in this paper.},}^{^{3
Present address: Division of Child Neurology, Department of Pediatrics, The University Children's Hospital, University of Bern, Bern, Switzerland.}}, Suzanne Laughlin, MD ^b,^c, Sujatha Parthasarathy, MBBS ^a, Adriane Sinclair, MD ^a,^{^{4
Present address: Neurosciences Division, Lady Cilento Children's Hospital, University of Queensland, Brisbane, Australia.}}, Peter Dirks, MD, PhD ^d, Ann Marie Pontigon, MBA ^a, Mahendranath Moharir, MD ^a, Rand Askalan, MD ^a, Daune MacGregor, MD ^a, Gabrielle deVeber, MD ^a,^e
^a Division of Neurology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
^b Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
^c Division of Neuroradiology, Department of Medical Imaging, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
^d Division of Neurosurgery, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
^e Child Health Evaluative Sciences Program, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada

^∗Communications should be addressed to: Andrade; Department of Paediatrics; Neurology Section; Schulich School of Medicine and Dentistry; University of Western Ontario; London, Ontario N6A 5W9, Canada.Department of PaediatricsNeurology SectionSchulich School of Medicine and DentistryUniversity of Western OntarioLondonOntarioN6A 5W9Canada

Abstract

Background

Malignant middle cerebral artery infarct syndrome is a potentially fatal complication of stroke that is poorly understood in children. We studied the frequency, associated characteristics, and outcomes of this condition in children.

Methods

Children, aged two months to 18 years with acute middle cerebral artery infarct diagnosed at our center between January 2005 and December 2012 were studied. Associations with malignant middle cerebral artery infarct syndrome were sought, including age, seizures, neurological deficit severity (Pediatric National Institute of Health Stroke Severity Score), stroke etiology, fever, blood pressure, blood glucose, infarct location, infarct volume (modified pediatric Alberta Stroke Program Early Computed Tomography Score), and arterial occlusion. Death and neurological outcomes were determined.

Results

Among 66 children with middle cerebral artery stroke, 12 (18%) developed malignant middle cerebral artery infarct syndrome, fatal in three. Prolonged seizures during the first 24 hours (odds ratio, 25.51; 95% confidence interval, 3.10 to 334.81; P = 0.005) and a higher Pediatric National Institute of Health Stroke Severity Score (odds ratio, 1.22; 95% confidence interval, 1.08 to 1.45; P = 0.006) were independently associated with malignant middle cerebral artery infarct syndrome. All children aged greater than two years with a Pediatric National Institute of Health Stroke Severity Score ≥8 and initial seizures ≥5 minutes duration developed malignant middle cerebral artery infarct syndrome (100%).

Conclusions

Malignant middle cerebral artery infarct syndrome affects nearly one in five children with acute middle cerebral artery stroke. Children with higher Pediatric National Institute of Health Stroke Severity Scores and prolonged initial seizures are at greatly increased risk for malignant middle cerebral artery infarct syndrome. Children with middle cerebral artery infarcts warrant intensive neuroprotective management and close monitoring to enable early referral for hemicraniectomy surgery.

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Keywords : infarction, middle cerebral artery, children, seizures, hemicraniectomy

Plan

Introduction

Patients and Methods

Participants and study design

Clinical data

Standard protocol approvals, registrations, and patient consents

MMCAI frequency and associations

Clinical outcomes

Discussion

Author Disclosures: Andrea Andrade, Sandra Bigi, Suzanne Laughlin, Sujatha Parthasarathy, Adriane Sinclair, Peter Dirks, Ann Marie Pontigon, Mahendranath Moharir, Rand Askalan, and Daune MacGregor report no disclosure. Gabrielle deVeber is supported by Auxilium Foundation and by NINDS R01 NS062820.

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P. 44-51 - novembre 2016 Retour au numéro

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Association Between Prolonged Seizures and Malignant Middle Cerebral Artery Infarction in Children With Acute Ischemic Stroke - 29/10/16

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