Could infarct location predict the long-term functional outcome in childhood arterial ischemic stroke?

López-Espejo, Mauricio; Hernández-Chávez, Marta

doi:10.1590/0004-282X20170124

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Article • Arq. Neuro-Psiquiatr. 75 (10) • Oct 2017 • https://doi.org/10.1590/0004-282X20170124 copy

Could infarct location predict the long-term functional outcome in childhood arterial ischemic stroke?

¿Puede la localización del infarto predecir el resultado funcional a largo plazo en el ictus isquémico arterial pediátrico?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To explore the influence of infarct location on long-term functional outcome following a first-ever arterial ischemic stroke (AIS) in non-neonate children.

Method:

The MRIs of 39 children with AIS (median age 5.38 years; 36% girls; mean follow-up time 5.87 years) were prospectively evaluated. Infarct location was classified as the absence or presence of subcortical involvement. Functional outcome was measured using the modified Rankin scale (mRS) for children after the follow-up assessment. We utilized multivariate logistic regression models to estimate the odds ratios (ORs) for the outcome while adjusting for age, sex, infarct size and middle cerebral artery territory involvement (significance < 0.05).

Results:

Both infarcts ≥ 4% of total brain volume (OR 9.92; CI 1.76 – 55.9; p 0.009) and the presence of subcortical involvement (OR 8.36; CI 1.76 – 53.6; p 0.025) independently increased the risk of marked functional impairment (mRS 3 to 5).

Conclusion:

Infarct extension and location can help predict the extent of disability after childhood AIS.

Keywords:
stroke; disability; cerebrovascular disorders; cerebral infarction

Variables		With subcortical infarct	Without subcortical infarct	p-value
Overall, n (%)		26 (67)	13 (33)
Demographics and treatment
	Female, n (%)	11 (42.3)	3 (23.1)	0.304
	Male, n (%)	15 (577)	10 (76.9	0.304
	Age in years, mean (SD)	6.16 (5.37)	3.83 (4.20)	0.148
	Time of follow-up, mean (SD)	4.95 (2.69)	4.93 (1.98)	0.982
	Anticoagulant treatment, n (%)	19 (73.1)	10 (76.9)	0.999
Clinical presentation
	GCS < 12, n (%)	12 (46.2)	8 (61.5)	0.501
	Headache, n (%)	5 (19.2)	2 (15.4)	1.000
	Acute seizures, n (%)	9 (34.6)	5 (38.5)	1.000
	Focal neurologic deficits, n (%)	20 (76.9)	9 (69.2)	0.704
Stroke etiology
	Cardioembolic, n (%)	11 (42.3)	6 (46.2)	1.000
	Arteriopathy, n (%)	5 (19.2)	2 (15.4)	1.000
	Thrombophilia^* * Including acquired and genetic thrombophilias; , n (%)	2 (77)	1 (7.7)	1.000
	Other etiology^ Head/neck trauma (3), Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (2), intracranial tumor (1). GCS: Glasgow coma scale; ACA: anterior cerebral artery; MCA: middle cerebral artery; PCA: posterior cerebral artery; TBV: total brain volume. , n (%)	3 (11.5)	3 (23.1)	0.380
	Multifactorial, n (%)	3 (11.5)	0 (0)	0.538
	Undetermined, n (%)	5 (19.2)	2 (15.4)	1.000
Stroke-related radiological variables
	Right sided, n (%)	15 (57.7)	7 (53.8)	1.000
	ACA territory, n (%)	11 (42.3)	3 (23.1)	0.304
	MCA territory, n (%)	11 (42.3)	7 (53.8)	0.520
	PCA territory, n (%)	4 (15.4)	3 (23.1)	0.666
	Large lesion (≥ 4% TBV), n (%)	17 (65.4)	6 (46.2)	0.312
	Stroke recurrence, n (%)	3 (13)	1 (8.3)	1.000

Variable		Univariate		Multivariate^* * Adjusted for age;		Multivariate^ Adjusted for age, stroke location, size and MCA infarct.
Variable		OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value
Subcortical involvement
	Minimal or absent impairment	Reference		Reference		Reference
	Marked impairment	6.5 (1.2-36.6)	0.03	778 (1.3-479)	0.02	9.33 (1.2-72.3)	0.03
Large lesion (≥ 4% TVB)
	Minimal or absent impairment	Reference		Reference		Reference
	Marked impairment	743 (1.6-35.5)	0.01	7.54 (1.6-36.3)	0.01	764 (1.3- 43.4)	0.02
MCA infarct
	Minimal or absent impairment	Reference		Reference		Reference
	Marked impairment	1.71 (0.4-6.6)	0.44	1.77 (0.4-72)	0.42	2.75 (0.5-16.4)	0.27

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[1] Correspondence: Mauricio López-Espejo; Unit of Neurology. Division of Pediatrics. School of Medicine. Pontifícia Universidad Católica of Chile. Lira 85, Postal: 6510273 Santiago Chile; E-mail: mlopeze@med.puc.cl