The medical records of all children at our hospital with International Classification of Diseases 9th revision (ICD-9) codes 342, 433 to 438, or 767 from May 1999 to May 2004 were reviewed to assess whether they had stroke (any type) or, specifically, arterial ischemic stroke (AIS). Code accuracy ranged from 37 to 88%; each code missed more than half of AIS identified by the combined code search. Studies are needed to determine whether other local and national ICD-9 databases have similar limitations.
"Before the advent of MRI techniques , a Mayo Clinic retrospective analysis of cases in Rochester, Minnesota , in the late 1970s yielded an incidence of 2.5 strokes per 100,000 children per year . Although pre-MRI data likely underestimate the incidence of AIS because of the low sensitivity of CT for ischemia, more recent retrospective analyses using medical record review are subject to well-documented inaccuracies engendered by the International Statistical Classification of Diseases, 9th Revision coding . In addition, given the low index of suspicion for cerebrovascular events in children, the true incidence of pediatric AIS likely remains underdiagnosed. "
[Show abstract][Hide abstract] ABSTRACT: Arterial ischemic stroke (AIS) is a rare disorder in children. Research suggests that risk factors, outcomes, and presentation are different from those of adult stroke. In particular, prothrombotic abnormalities and large vessel arteriopathies that are nonatherosclerotic seem to play a large role in the pathogenesis of childhood AIS. This review examines the epidemiology and etiologies of neonatal and childhood AIS and provides a detailed discussion of approaches to the clinical characterization, diagnostic evaluation, and management. Long-term outcomes of recurrent AIS and neuromotor, speech, cognitive, and behavioral deficits are considered. Emphasis is on evidence underlying current knowledge and key questions for further investigation.
Hematology/oncology clinics of North America 02/2010; 24(1):167-80. DOI:10.1016/j.hoc.2009.11.007 · 2.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the prevalence of epilepsy after 6 months of age in children with perinatal stroke and examine whether perinatal data predict epilepsy onset and resolution.
A retrospective review of 64 children with perinatal stroke. In children with at least 6 months of follow-up data, Kaplan-Meier curves, univariate log-rank tests, and Cox proportional hazards models were used to examine predictors of time to development of seizures, and time to resolution of seizures in children with epilepsy. The association of risk factors with the presence of epilepsy at any time after 6 months of age was examined using Fisher's exact test.
Forty-one of the 61 children with at least 6 months of follow-up data (67%) had epilepsy between 6 months of age and last follow-up, but in 13 of 41, seizures eventually resolved and anticonvulsants were discontinued. Infarct on prenatal ultrasonography (P = .0065) and family history of epilepsy (P = .0093) were significantly associated with time to development of seizures after 6 months of age in the univariate analysis. No assessed variables were associated with time to resolution of epilepsy or with the presence of epilepsy after 6 months of age.
Childhood epilepsy is frequent after perinatal stroke. Evidence of infarction on prenatal ultrasonography and a family history of epilepsy predict earlier onset of active seizures.
The Journal of pediatrics 11/2007; 151(4):409-13, 413.e1-2. DOI:10.1016/j.jpeds.2007.03.058 · 3.79 Impact Factor
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