Epidemiology of neonatal stroke: A population-based study

Abstract Objective The goal of this study was to obtain population-based data on the incidence, clinical presentation, management, imaging features, and long-term outcomes of patients with all types of neonatal stroke (NS). Methods Full-term neonates with NS born between January 2007 and December 2013 were identified through the Nova Scotia Provincial Perinatal Follow-up Program Database. Perinatal data and neonatal course were reviewed. Neurodevelopmental outcomes were assessed at 18 and 36 months of age using standardized testing. Results Twenty-nine neonates with NS were identified during the study period, giving an incidence of 47 per 100,000 live births in Nova Scotia. Arterial ischemic stroke was the most common stroke type (76%), followed by neonatal hemorrhagic stroke (17%), then cerebral sinovenous thrombosis (7%). The majority of neonates presented with seizures (86%) on the first day of life (76%). At 36 months of age, 23 (79%) of the children had a normal outcome, while 3 (10%) were diagnosed with cerebral palsy (2 with neonatal arterial stroke and one with neonatal hemorrhagic stroke) and 3 (10%) had recurrent seizures (1 patient from each stroke subtype group). Conclusion The incidence of NS in Nova Scotia is higher than what has been reported internationally in the literature. However, the neurodevelopmental outcomes at 3 years of age are better. Further studies are required to better understand the reasons for these findings.

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B.3 The incidence of perinatal stroke is 1:1200 births in Southern Alberta: Population-based incidence of disease-specific perinatal stroke

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.272 ◽

2021 ◽

Vol 48 (s3) ◽

pp. S16-S16

Author(s):

M Dunbar ◽

J Hodge ◽

A Floer ◽

A Kirton

Keyword(s):

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Case Series ◽

Population Based ◽

Arterial Ischemic Stroke ◽

Stroke Incidence ◽

Perinatal Stroke ◽

Cerebral Sinovenous Thrombosis ◽

Southern Alberta ◽

Disease Specific

Background: Perinatal stroke encompasses six cerebrovascular syndromes which occur between the 20th week of gestation and the 28th post-natal day. Subtypes are neonatal arterial ischemic stroke (NAIS), neonatal cerebral sinovenous thrombosis (CSVT), neonatal hemorrhagic stroke (NHS), arterial presumed perinatal ischemic stroke (APPIS), periventricular venous infarction (PVI), and presumed perinatal hemorrhagic stroke (PPHS). Inconsistent terminology and lack of population-based case series has limited accurate measurement of disease-specific perinatal stroke incidence. Our objective was to define the incidence of the subtypes of perinatal stroke using a population-based cohort. Methods: The Alberta Perinatal Stroke Project is a research cohort established in 2008 in Southern Alberta. Case acquisition included retrospective hospital and ICD code searches (1990-2008) and prospective enrollment from all NICU and neurology/stroke clinics (2008-2017). Results: The overall incidence of perinatal stroke in Southern Alberta was 9.0 cases per 10,000 births, or 1:1200 births. Per 10,000 births, the incidence of each subtype was: NAIS = 3.2 (~1:3000), APPIS =1.2 (~1:8500), PVI = 1.5 (~1:6500), CSVT = 1.0 (~1:9900), NHS = 1.4 (~1/7300), PPHS = 0.1 (1/82,000). Conclusions: The overall incidence of perinatal stroke in Southern Alberta is 1:1200 live births. Population-based sampling of disease-specific states may explain why this rate is much higher than previous estimates

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Abstract 74: The Epidemiology of Childhood Stroke in Southern England: A Prospective Study using Multiple Sources of Case Ascertainment

Stroke ◽

10.1161/str.44.suppl_1.a74 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Andrew A Mallick ◽

Vijeya Ganesan ◽

Fenella J Kirkham ◽

Penny Fallon ◽

Tammy Hedderly ◽

...

Keyword(s):

Age Distribution ◽

Epidemiological Data ◽

Population Based ◽

Gender Disparity ◽

Childhood Stroke ◽

Multiple Sources ◽

Arterial Ischemic Stroke ◽

Southern England ◽

Cerebral Sinovenous Thrombosis ◽

Increased Risk

Background: Epidemiological data are vital to quantify the scale of disease and can provide insights into aetiological factors. Objective: To describe the epidemiology of childhood stroke in southern England. Methods: Children (>28 days to <16 years) residing in southern England (5.99 million children) who had arterial ischemic stroke (AIS), cerebral sinovenous thrombosis with venous infarction (CSVT) and hemorrhagic stroke (HS) between July 2008 and June 2009 were identified. Multiple sources including pediatric neurologists, pediatricians, neurosurgeons, radiologists, physiotherapists, a national intensive care audit system, and parents notified cases. Results: 153 cases of stroke were identified (96 cases of AIS, 14 cases of CSVT and 43 cases of HS). The incidence for overall stroke was 2.56 per 100,000 person years (95% CI 2.15 - 2.96). The age distribution is shown in Figure 1. There was no difference between males and females in the risk of ischemic (AIS and CSVT) stroke (RR=1.06, p=0.75), HS (RR=1.46, p=0.22) or overall stroke (RR=1.16, p=0.36). Compared to Whites the relative risk of ischaemic stroke was higher for Asians (RR=2.35, p=0.001) and Blacks (RR=2.52, p=0.003). There was no increased risk of HS for Asians (RR=0.84, p=0.77) or Blacks (RR=1.39, p=0.58). Conclusions: The incidence of childhood stroke found by this study is higher than previously found in the UK. This is the first study to show disparities in the risk of childhood stroke between ethnic groups in Europe. Although an increased risk for males is commonly reported a number of recent population based studies have found no gender disparity.

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Population-based Comparison Study on the Costs of Stroke Care for Women with Dysmenorrhea

10.21203/rs.3.rs-279491/v1 ◽

2021 ◽

Author(s):

Ya-Wen Lin ◽

Fung-Chang Sung ◽

Ming-Hung Lin ◽

Chih-Hsin Mou ◽

Yu-Kuei Teng ◽

...

Keyword(s):

Hemorrhagic Stroke ◽

Stroke Care ◽

Population Based ◽

Research Database ◽

Comparison Study ◽

Stroke Subtype ◽

Outpatient Visits ◽

Increased Risk ◽

Insurance Claims Data

Abstract Background No study has investigated costs of stroke care for women with dysmenorrhea and stroke. This study compared types of stroke and costs of stroke care between women with and without dysmenorrhea, using the National Health Insurance Research Database of Taiwan. Methods From the insurance claims data, we identified women aged 15–44 to establish study cohorts with and without dysmenorrhea, frequency matched by age, with same sample size of 66048. Incidence of stroke and costs by stroke subtype were compared between the two cohorts at the end of follow-up. Results The incidence of stroke was 1.3-fold greater in the dysmenorrhea cohort than in comparisons. Proportionally, hemorrhagic stroke (HS) decreased with age, whereas ischemic stroke (IS) increased with age in both cohorts. Compared to comparisons, dysmenorrhea women had lower proportions of both HS (16.6% vs. 21.3%) and IS (19.8 vs. 20.1%), whereas dysmenorrhea women had higher proportion of transient cerebral ischemia (TIA) (31.3 vs. 24.2%). The average HS care and IS care cost ratios were 4.1 (3254/789, USD) for dysmenorrhea women, and 3.3-fold (3870/1171, USD) for comparisons. Hospitalization rate was lower in the dysmenorrhea than in comparisons (18.0 vs. 23.4%). Dysmenorrhea was associated with an increased risk of HS hospitalized (adjusted odds ratio (aOR) = 1.26, 95% confidence interval (CI) 0.71–2.23), but a lowered risk for IS (aOR = 0.48, 95% CI 0.21–0.69). Average costs for inpatient care, intensive care units, emergency and outpatient visits for dysmenorrheal women were all less than that for comparisons, but not significant. Conclusion The overall incidence of stroke was higher in dysmenorrheal women than in comparisons due to a higher proportion of TIA, but not HS and IS. However, costs for stroke care were slightly lower for dysmenorrhea women than for comparisons.

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Pediatric Stroke: Clinical Findings and Radiological Approach

Stroke Research and Treatment ◽

10.4061/2011/172168 ◽

2011 ◽

Vol 2011 ◽

pp. 1-11 ◽

Cited By ~ 7

Author(s):

Giuseppe Lanni ◽

Alessia Catalucci ◽

Laura Conti ◽

Alessandra Di Sibio ◽

Amalia Paonessa ◽

...

Keyword(s):

Ischemic Stroke ◽

Magnetic Resonance ◽

Hemorrhagic Stroke ◽

Clinical Findings ◽

Pediatric Stroke ◽

Arterial Ischemic Stroke ◽

Venous Circulation ◽

Cerebral Sinovenous Thrombosis ◽

First Choice ◽

Sinovenous Thrombosis

This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis) and hemorrhagic stroke. Etiopathology and main clinical findings are examined as well. Magnetic Resonance Imaging could be considered as the first-choice diagnostic exam, offering a complete diagnostic set of information both in the discrimination between ischemic/hemorrhagic stroke and in the identification of underlying causes. In addition, Magnetic Resonance vascular techniques supply further information about cerebral arterial and venous circulation. Computed Tomography, for its limits and radiation exposure, should be used only when Magnetic Resonance is not available and on unstable patients.

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Abstract 51: The Incidence of Perinatal Stroke is 1:1200 Live Births: A Population-Based Study in Alberta Canada

Stroke ◽

10.1161/str.51.suppl_1.51 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Mary J Dunbar ◽

Adam Kirton

Keyword(s):

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Tertiary Care ◽

Population Based ◽

Stroke Incidence ◽

Perinatal Stroke ◽

Live Births ◽

Cerebral Sinovenous Thrombosis ◽

Southern Alberta ◽

Disease Specific

Introduction: Perinatal stroke encompasses six cerebrovascular syndromes which occur between the 20 th week of gestation and the 28 th post-natal day. Morbidity is significant including motor, language, behavioral, and cognitive challenges, as well as epilepsy. Acute presentations include neonatal arterial ischemic stroke (NAIS), neonatal cerebral sinovenous thrombosis (CSVT), and neonatal hemorrhagic stroke (NHS). Delayed presentations include arterial presumed perinatal ischemic stroke (APPIS), periventricular venous infarction (PVI), and presumed perinatal hemorrhagic stroke (PPHS). Inconsistent terminology and lack of population-based cohorts has limited accurate measurement of disease-specific perinatal stroke incidence. Our objective was to define the incidence of the subtypes of perinatal stroke using a population-based cohort. Methods: The Alberta Perinatal Stroke Project is a research cohort established in 2008 in Southern Alberta, Canada (population ~2.1 million). Leveraging universal health care at a single tertiary care pediatric center facilitated true population-based epidemiology. Patients included had neuroimaging-confirmed perinatal stroke. Case acquisition included exhaustive retrospective hospital and ICD code searches (1990-2008) and prospective enrollment from all NICU and neurology/stroke clinics (2008-2018). Live birth rate denominators were determined from the provincial census. Results: The overall incidence of perinatal stroke in Southern Alberta from 2008-2018 was 81 cases per 100,000 live births, or 1 case per approximately 1200 live births. The incidence of NAIS was 31 per 100,000 (~1/3000), APPIS was 11 per 100,000 (~1/9000), PVI was 18 per 100,000 (~1/5500), and CSVT was 10 per 100,000 (~1/9800). The incidence of NAIS increased after implementing prospective case identification, from 8.5 (95% CI 5.3-11.6) per 100,000 to 31 per 100,000 (95% CI 24.4-38.2), p<0.00001, the remainder of stroke subtypes were stable over time. Conclusions: The overall incidence of perinatal stroke in Southern Alberta is 1:1200 live births. Population-based sampling of disease-specific states may explain why this rate is much higher than previous estimates.

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Risk of hemorrhagic and ischemic stroke in patients with Alzheimer disease

Neurology ◽

10.1212/wnl.0000000000008924 ◽

2020 ◽

Vol 94 (6) ◽

pp. 265-272

Author(s):

Reem Waziry ◽

Lori B. Chibnik ◽

Daniel Bos ◽

M. Kamran Ikram ◽

Albert Hofman

Keyword(s):

Ischemic Stroke ◽

Relative Risk ◽

Alzheimer Disease ◽

Hemorrhagic Stroke ◽

Meta Analysis ◽

Population Based ◽

Stroke Subtype ◽

Risk Profiles ◽

Matching Criteria ◽

Similar Risk

ObjectiveTo assess the risk of hemorrhagic and ischemic stroke in patients with Alzheimer disease (AD) compared with non-AD controls with similar risk profiles.MethodsA search was conducted on EMBASE and MEDLINE for reports published up to September 26, 2018. Studies were included if they (1) assessed the incidence of stroke in patients diagnosed with AD; (2) included patients with no history of stroke; and (3) reported outcomes by stroke subtype. The main outcome was relative risk of ischemic or hemorrhagic stroke. Furthermore, the rate of stroke occurrence per 1,000 person-years was assessed. A random-effects meta-analysis was undertaken. The risk of bias in included studies was assessed in terms of selection, comparability, and outcome.ResultsA total of 3,605 studies were screened in the title and abstract phase after removing duplicates, and 88 eligible studies were screened for full text. Eight studies met the inclusion criteria representing 121,719 individuals (AD = 73,044; non-AD = 48,675). Five studies were included in the relative risk analysis, among which 4 studies applied formal matching criteria of 44,544 AD and 44,660 non-AD controls. The included studies were based on nationwide registries from Finland, Sweden, Taiwan (2), United Kingdom (2), 1 clinic-based study from the Netherlands, and 1 US population–based cohort. Among patients with AD, the incidence rate of hemorrhagic stroke was 3.41/1000 person-years (95% CI 2.70–4.32) and 2.23 (95% CI 1.72–2.88) among AD cases and non-AD controls, respectively. This is in contrast to 13.98 (95% CI 9.86–19.81) and 12.12 (95% CI 7.55–19.46) for ischemic stroke among AD cases and non-AD controls, respectively. Compared with non-AD controls with similar risk profiles, patients with AD had a relative risk of 1.42 (95% CI 1.23–1.64) for hemorrhagic stroke and 1.15 (95% CI 0.89–1.48) for ischemic stroke.ConclusionCompared with non-AD controls with similar risk profiles, patients with AD are likely at a higher risk of hemorrhagic but not ischemic stroke.

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Effect of COPD on the Hospital Outcomes and Mortality among Hemorrhagic Stroke Patients. Sex Differences in a Population-Based Study

Journal of Clinical Medicine ◽

10.3390/jcm10112491 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2491

Author(s):

Javier de Miguel-Diez ◽

Marta Lopez-Herranz ◽

Rodrigo Jiménez-García ◽

Valentín Hernández-Barrera ◽

Isabel Jimenez-Trujillo ◽

...

Keyword(s):

Sex Differences ◽

Decompressive Craniectomy ◽

Hemorrhagic Stroke ◽

Population Based ◽

Stroke Patients ◽

National Hospital ◽

Population Based Study ◽

Factors Associated ◽

Adjusted Incidence ◽

Discharge Database

(1) Background: It is not well known whether there is an association between COPD and hemorrhagic stroke (HS). We aim to analyze the incidence, clinical characteristics, procedures, and outcomes of HS in patients with and without COPD and to assess sex differences. Secondly, to identify factors associated with in-hospital mortality (IHM). (2) Methods: Patients aged ≥40 years hospitalized with HS included in the Spanish National Hospital Discharge Database (2016–2018) were analyzed. Propensity score matching (PSM) was used to compare patients according to sex and COPD status. (3) Results: We included 55,615 patients (44.29% women). Among men with COPD the HS adjusted incidence was higher (IRR 1.31; 95% CI 1.24–1.57) than among non-COPD men. COPD men had higher adjusted incidence of HS than COPD women (IRR 1.87; 95% CI 1.85–1.89). After matching, COPD men had a higher IHM (29.96% vs. 27.46%; p = 0.032) than non-COPD men. Decompressive craniectomy was more frequently conducted among COPD men than COPD women (6.74% vs. 4.54%; p = 0.014). IHM increased with age and atrial fibrillation, while decompressive craniectomy reduced IHM. (4) Conclusions: COPD men had higher incidence and IHM of HS than men without COPD. COPD men had higher incidence of HS than COPD women. Decompressive craniectomy was more frequently conducted in COPD men than COPD women and this procedure was associated to better survival.

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Head circumference trajectory in children with perinatal stroke

Journal of Child Neurology ◽

10.1177/0883073821996103 ◽

2021 ◽

pp. 088307382199610

Author(s):

Amanda Leong ◽

Amalia Floer ◽

Adam Kirton ◽

Aleksandra Mineyko

Keyword(s):

Ischemic Stroke ◽

Head Circumference ◽

Developmental Outcomes ◽

Normal Growth ◽

Fisher Exact Test ◽

Arterial Ischemic Stroke ◽

Neurodevelopmental Outcomes ◽

Perinatal Stroke ◽

Head Growth ◽

Poor Outcome

Background: Perinatal stroke is a leading cause of hemiparetic cerebral palsy and lifelong disability. Neurodevelopmental outcomes are difficult to predict and markers of long-term poor outcome continue to be investigated. Deceleration in growth of head circumference has been associated with worse developmental outcomes in neonatal brain injury. We hypothesized that perinatal stroke would result in decreased rates of head growth during childhood that would be associated with worse developmental outcomes. Methods: Patients with magnetic resonance imaging (MRI)–confirmed neonatal arterial ischemic stroke and arterial presumed perinatal ischemic stroke were identified from a population-based research cohort (Alberta Perinatal Stroke Project). Demographics and occipital-frontal circumference data were collected from medical records. Head growth was compared to typically developing control charts using a 2-tailed t test. The Fisher exact test was used to examine associations between Pediatric Stroke Outcome Measures (PSOM) scores and occipital-frontal head circumference. Results: Three hundred fifteen occipital-frontal head circumference measurements were collected from 102 patients (48 female, 54 male), over a median of 3.2 years (standard deviation = 5.18, range = 0-18.3). After 3 months for female patients and 1 year for male patients, occipital-frontal head circumference deviated and remained below normal growth trajectories ( P < .05) with a large effect size (Cohen d >0.8). Poor outcome (PSOM ≥ 1) was associated with smaller occipital-frontal head circumference ( P < .05). Conclusion: Head growth deceleration is observed in children with perinatal arterial ischemic stroke and is associated with poor outcome. Head circumference may be a tool to alert clinicians to the potential of abnormal neurologic outcome.

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Abstract 17: Prehospital Deterioration During Transport by Emergency Medical Services for Stroke Patients: A Population-Based Study

Stroke ◽

10.1161/str.48.suppl_1.17 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sabreena J Gillow ◽

Heidi Sucharew ◽

Kathleen Alwell ◽

Charles J Moonmaw ◽

Daniel Woo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Multivariate Analysis ◽

Univariate Analysis ◽

Onset Time ◽

Population Based ◽

Neurological Deterioration ◽

Stroke Patients ◽

Stroke Subtype ◽

Hospital Arrival ◽

Neurologic Deterioration

Introduction: Stroke patients can experience neurological change in the prehospital setting. We sought to identify factors associated with prehospital neurologic deterioration. Methods: Among the Greater Cincinnati/Northern Kentucky region (pop. ~1.3 million), we screened all 15 local hospitals’ admissions from 2010 for acute stroke, and included patients with age ≥20 and complete EMS records. Glasgow Coma Scale (GCS) at hospital arrival was compared with GCS evaluated by EMS, with decrease ≥2 points considered neurologic deterioration. Data obtained included age, sex, race, medical history, antiplatelet or anticoagulant use, stroke subtype [ischemic (IS), ICH, or SAH] and IS subtype (e.g., small vessel, large vessel, cardioembolic), seizure at onset, time from symptom onset to EMS arrival, time from EMS to hospital arrival, blood pressure and serum glucose on EMS arrival, and EMS level of training. Univariate analysis was completed using Wilcoxon rank sum test for continuous measures and chi-square or Fisher’s exact test for categorical measures. Multivariate analysis was completed on variables with p ≤ 0.20 in the univariate analysis. Results: Of 2708 total stroke patients, 1097 (870 IS, 176 ICH, 51 SAH) had EMS records (median [IQR] age 74 [61, 83] years; 56% female; 21% black). Onset to EMS arrival was ≤4.5 hours for 508 cases (46%), and median time from EMS to hospital arrival was 26 minutes. Neurological deterioration occurred in 129 cases (12%), including 9.1% of IS and 22% of ICH/SAH. In multivariate analysis, black race, atrial fibrillation, ICH or SAH subtype, and ALS transport were associated with neurological deterioration. Conclusion: Atrial fibrillation may predict prehospital deterioration in stroke, and preferential transport of patients with acute worsening to centers capable of managing hemorrhagic stroke may be justifiable. Further studies are needed to identify why race is associated with deterioration and potential areas of intervention.

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Symptom patterns in childhood arterial ischemic stroke: Analysis of a population-based study in Germany

Klinische Pädiatrie ◽

10.1055/a-0684-9794 ◽

2018 ◽

Vol 230 (06) ◽

pp. 319-325

Author(s):

Lucia Gerstl ◽

Raphael Weinberger ◽

Rüdiger von Kries ◽

Florian Heinen ◽

Andreas Sebastian Schroeder ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Symptoms ◽

Population Based ◽

Case Definition ◽

Childhood Stroke ◽

Older Children ◽

Arterial Ischemic Stroke ◽

Focal Neurological Deficit ◽

Symptom Patterns ◽

Specific Symptoms

Hintergrund Die zeitliche Verzögerung zwischen Symptombeginn und Diagnose ist eine Herausforderung in der Behandlung von Kindern mit arteriell ischämischem Schlaganfall. Frühere Studien zur klinischen Präsentation beschäftigten sich v. a. mit kumulativen Symptomen. Zielsetzung Ziel dieser Studie ist es, mögliche Symptommuster aufzuzeigen. Methoden In einer aktiven Beobachtungsstudie zwischen 01/2015 und 12/2016 (ESPED-Studie) wurden Kinder mit Erstdiagnose eines arteriell ischämischen Schlaganfalls eingeschlossen. Isoliert auftretende Erstsymptome wurden verschiedenen Symptomkombinationen gegenübergestellt. Zudem wurde untersucht, inwieweit ein als „akut“ oder „progredient“ klassifiziertes Auftreten der Symptome Rückschlüsse auf die zugrundeliegende Ätiologie erlaubt. Ergebnisse Es wurden 99 Kinder in die Studie eingeschlossen. Unabhängig vom Alter traten überwiegend fokale Symptome auf (86%). Krampfanfälle als Initialsymptom wurden insbesondere bei Säuglingen beschrieben (67%), wohin-gegen diffuse, unspezifische Symptome vor allem bei Vorschulkindern (38%) und älteren Kindern (59%) auftraten. Isoliert traten fokale Symptome bei 37 Kindern auf, 48 Kinder zeigten zusätzlich unspezifische Symptome, darunter auch 9 Kinder mit Krampfanfällen. Isolierte unspezifische Symptome zeigten sich lediglich bei 7 Kindern, 2 Kinder wurden nur mit Krampfanfällen symptomatisch. Die Akuität des Symptombeginns wurde bei 53/78 als „akut“ und bei “25/78 Fällen als „progredient“ klassifiziert, lieferte jedoch keinen Hinweis auf die zugrundeliegende Ätiologie. Schlussfolgerung Jedes neue fokal neurologische Defizit sollte unabhängig vom Auftreten (isoliert oder kombiniert, akut oder progredient) an einen kindlichen Schlaganfall denken lassen. Background Time delay between onset of clinical symptoms and diagnosis is a challenge in childhood arterial ischemic stroke. Most previous studies reported cumulative symptoms. Objective We attempted to identify typical symptom patterns and assessed their emergence in childhood stroke. Methods Prospective active surveillance in ESPED, a hospital based Pediatric Surveillance Unit for rare diseases in Germany, between January 2015 and December 2016. Case definition: first diagnosis of a radiologically confirmed arterial ischemic stroke. Symptom patterns were identified as occurring in isolation or in combination. We distinguished acute vs. progressive onset. We ascertained risk factors to identify the possible etiology. Results 99 children with childhood arterial ischemic stroke were reported. Focal symptoms were the predominant presenting feature (86%), independent of age. Seizures were more often seen in infants < 1 year (67%), whereas diffuse symptoms were more present in pre-school children (38%) and older children (59%). 37 children had focal features alone and 48 additional non-specific features, including 9 with seizures. Isolated non-specific features accounted for 7 cases, and 2 children had (focal) seizures as the only symptom. In 77% of all cases at least one risk factor was identified. The emergence of symptoms was acute in 53/78 cases and progressive in 25/78 cases. The pattern of emergence was unrelated to the underlying etiology. Conclusions Any new focal neurological deficit in isolation, or associated with seizures or further non-specific symptoms should alert to childhood stroke.

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