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Arterial ischemic stroke in infants, children, and adolescents: results of a Germany-wide surveillance study 2015–2017

  • Lucia GerstlEmail author
  • Raphael Weinberger
  • Florian Heinen
  • Michaela V. Bonfert
  • Ingo Borggraefe
  • A. Sebastian Schroeder
  • Moritz Tacke
  • Mirjam N. Landgraf
  • Katharina Vill
  • Karin Kurnik
  • Anna-Lisa Sorg
  • Martin Olivieri
Original Communication

Abstract

Objective

Childhood arterial ischaemic stroke (AIS) is rare, but causes significant morbidity and mortality. We aimed to investigate incidence, age-dependent clinical presentation, and risk factors and to discuss the medical care situation in Germany.

Methods

This prospective epidemiological study was conducted via ESPED (Erhebungseinheit für Seltene Pädiatrische Erkrankungen in Deutschland), a hospital-based German nation-wide surveillance unit for rare pediatric diseases. Children aged 28 days–18 years with first AIS between January 2015 and December 2017 were included.

Results

In the 3-year period, 164 children were reported. Incidence showed peaks in infants, children < 2 years of age, and adolescents (12–18 years), with a significant male predominance observed in adolescents only. Independent of age, most children (91%) presented with focal symptoms, particularly with acute hemiparesis. The occurrence of seizures in infants (57%) and more nonspecific symptoms in school-children and adolescents (54%) is considered noteworthy. Prothrombotic states (34%), cardiac disorders (29%), and arteriopathies (19%) were the most frequently identified risk factors. The majority of children (72/131, thus 55%) were discharged home after acute care phase. At time of discharge, most common neurological symptoms were hemiparesis (42%), facial palsy (15%), and speech disturbance (12%).

Conclusion

This study provides population-based data of childhood AIS which may be useful for further research. The improvement of acute stroke management is needed for children, but also the standardization of post-stroke care in the outpatient setting has to be structured. Considering the higher stroke incidence in (male) adolescents, it is advisable to combine research activities in adolescents and young adults.

Keywords

Childhood stroke Pediatric stroke Symptoms Risk factors 

Notes

Acknowledgements

The authors thank all pediatricians reporting to ESPED.

Funding

Building up the database was financially supported by Friedrich-Baur-Stiftung, München.

Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standards statement

The study was approved by the ethics committee of the Medical Faculty of the Ludwig-Maximilians-University Munich, Number 42-15 (05-04-2015) and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Supplementary material

415_2019_9508_MOESM1_ESM.pdf (241 kb)
Supplementary file1 (PDF 240 kb)
415_2019_9508_MOESM2_ESM.pdf (1.5 mb)
Supplementary file2 (PDF 1541 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Lucia Gerstl
    • 1
    Email author
  • Raphael Weinberger
    • 2
  • Florian Heinen
    • 1
  • Michaela V. Bonfert
    • 1
  • Ingo Borggraefe
    • 1
  • A. Sebastian Schroeder
    • 1
  • Moritz Tacke
    • 1
  • Mirjam N. Landgraf
    • 1
  • Katharina Vill
    • 1
  • Karin Kurnik
    • 3
  • Anna-Lisa Sorg
    • 2
  • Martin Olivieri
    • 3
  1. 1.Department of Pediatric Neurology and Developmental MedicineLMU Munich, University Hospital, Dr. von Hauner Children`s HospitalMunichGermany
  2. 2.Division of Epidemiology, Institute of Social Pediatrics and Adolescent MedicineLMU MunichMunichGermany
  3. 3.Department of Pediatric Hemostasis and ThrombosisLMU Munich, University Hospital, Dr. von Hauner Children`s HospitalMunichGermany

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