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

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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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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Abstract P579: Fluid Attenuated Inversion Recovery Correlates With Time of Onset of Arterial Ischemic Stroke in Childhood

Stroke ◽

10.1161/str.52.suppl_1.p579 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Dennis Shaw ◽

Dwight Barry ◽

Michael G Abraham ◽

Dana D Cummings ◽

Mark T MacKay ◽

...

Keyword(s):

Tissue Injury ◽

Brain Mri ◽

Inversion Recovery ◽

Stroke Onset ◽

Childhood Stroke ◽

Arterial Ischemic Stroke ◽

Anterior Circulation ◽

Increased Risk ◽

Fluid Attenuated Inversion Recovery ◽

Highest Density Interval

Background: In adults, time since stroke onset correlates with efficacy and risk of recanalization therapies; beyond this temporal window there is increased risk of adverse events in particular hemorrhage with thrombolysis and decreased benefit of recanalization due to irreversible tissue injury. In adults the appearance of fluid attenuated inversion recovery (FLAIR) signal is a proxy for time, and is typically present by 6 hours. The time to FLAIR signal hyperintensity in childhood stroke is unknown but is of interest with potential utility due to the often greater uncertainty as to timing symptom onset. Methods: Time to FLAIR signal hyperintensity on brain MRI performed on children within 24 hours of stroke onset was studied with logistic regression. Results: A total of 68 MRIs with FLAIR imaging were available from 54 children (27 female), age 0.8 to 17.9 years, median 12.0 years. Seventy-four percent (40/54) of children and 72% (49/68) of scans had anterior circulation stroke. Interquartile range for time to FLAIR presence was 7.8 to 19.1 hours. The 90% probability of FLAIR change was reached at 11.2 hours for all strokes (Figure, dotted line; 80% highest density interval (HDI): 1.2-11.2 hours), and 9.3 hours for anterior circulation only strokes (Figure, solid line; 80% HDI: 3.3-9.3 hours), though nearly all had FLAIR change by 6 hours. FLAIR change was absent in 4 children after 6 hours, two with anterior circulation stroke (16 year-old at 6.1 hours, 10 year-old at 7.0 hours) and 2 with posterior circulation stroke (15 year-old at 7.3 hours, 9 month-old at 18.2 hours). Conclusion: Similar to adults, FLAIR hyperintensity can be used to estimate time since stroke ictus in childhood stroke. Children may have somewhat delayed time to FLAIR signal change compared with adults, suggesting that they may have a longer window for effective recanalization therapies.

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Asymptomatic pre-excitation

ESC CardioMed ◽

10.1093/med/9780198784906.003.0491 ◽

2018 ◽

pp. 2100-2105

Author(s):

Jonathan Chrispin ◽

Hugh Calkins

Keyword(s):

Atrial Fibrillation ◽

Clinical Symptoms ◽

Accessory Pathway ◽

Clinical Signs ◽

Epidemiological Data ◽

Population Based ◽

Increased Risk ◽

Pr Interval ◽

Life Threatening ◽

Electrocardiogram Ecg

Manifest pre-excitation on the surface electrocardiogram (ECG) with a short PR interval and delta wave occurs in a very small percentage of the population based on epidemiological data. For the vast majority, this ECG finding will have no clinical manifestation and over time the ECG manifestation of pre-excitation may even go away. A small minority of individuals, however, develop clinical signs related to ventricular pre-excitation, most notably atrioventricular reentrant (reciprocating) tachycardia. This non-life-threatening arrhythmia is associated with clinical symptoms of palpitations, dyspnoea, and presyncope. Those with ventricular pre-excitation are at increased risk for atrial fibrillation. Multiple invasive electrophysiological and longitudinal studies have shown that those with atrial fibrillation and robust conduction down the atrioventricular accessory pathway are at an increased risk of sudden cardiac death from ventricular fibrillation. This chapter reviews the available and recommended strategies for assessing the patient with asymptomatic pre-excitation.

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Epidemiology of neonatal stroke: A population-based study

Paediatrics & Child Health ◽

10.1093/pch/pxy194 ◽

2019 ◽

Vol 25 (1) ◽

pp. 20-25

Author(s):

Breanna Clive ◽

Michael Vincer ◽

Tahani Ahmad ◽

Naeem Khan ◽

Jehier Afifi ◽

...

Keyword(s):

Nova Scotia ◽

Standardized Testing ◽

Hemorrhagic Stroke ◽

Population Based ◽

Imaging Features ◽

Arterial Ischemic Stroke ◽

Stroke Subtype ◽

Neurodevelopmental Outcomes ◽

Neonatal Stroke ◽

Cerebral Sinovenous Thrombosis

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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Increased risk of non-multiple sclerosis demyelinating syndromes in patients with preexisting septicaemia: a nationwide retrospective cohort study

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-136667 ◽

2019 ◽

Vol 95 (1124) ◽

pp. 307-313

Author(s):

Chung-Hsing Chou ◽

Jiunn-Tay Lee ◽

Chia-Kuang Tsai ◽

Li-Ming Lien ◽

Jiu-Haw Yin ◽

...

Keyword(s):

Multiple Sclerosis ◽

Epidemiological Data ◽

Population Based ◽

Research Database ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Cox Proportional Hazard Regression ◽

The Relationship

BackgroundGrowing evidence shows links between septicaemia and non-multiple sclerosis demyelinating syndromes (NMSDS); nevertheless, epidemiological data are still very limited. This study aimed to explore the relationship between septicaemia and NMSDS in a general population.MethodsThe study included 482 781 individuals diagnosed with septicaemia and 1 892 825 age/sex-matched non-septicaemia patients for the comparison. Data were drawn from a population-based nationwide National Health Insurance Research Database Taiwan, from 1 January 2002 to 31 December 2011. The two cohorts of patients with and without septicaemia were followed up for the occurrence of NMSDS. The Cox-proportional hazard regression model was performed to estimate adjusted HR after multivariate adjustment.ResultsIndividuals with septicaemia had a 4.17-fold (95% CI 3.21 to 5.4, p < 0.001) higher risk to develop NMSDS compared with those without septicaemia. Patients aged <65 years had a greater NMSDS risk (<45 years: HR = 6.41, 95% CI 3.65 to 11.3, p < 0.001; 45–64 years: HR = 6.66, 95% CI 3.98 to 11.2, p < 0.001). Furthermore, females with septicaemia and individuals with higher severity of septicaemia were associated with increased risks of developing NMSDS.ConclusionsOur results indicated that patients with septicaemia were likely to develop NMSDS. A possible contributing role of septicaemia in increasing the hazard of NMSDS is proposed, based on the outcome that individuals with higher severity of septicaemia carried elevated threat of encountering NMSDS.

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Increased risk for hypothyroidism associated with carbon monoxide poisoning: a nationwide population-based cohort study

Scientific Reports ◽

10.1038/s41598-019-52844-9 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Chien-Cheng Huang ◽

Chung-Han Ho ◽

Yi-Chen Chen ◽

Chien-Chin Hsu ◽

Hung-Jung Lin ◽

...

Keyword(s):

Carbon Monoxide ◽

Cohort Study ◽

Carbon Monoxide Poisoning ◽

Epidemiological Data ◽

Population Based ◽

Monthly Income ◽

Potential Association ◽

Increased Risk ◽

Underlying Mechanisms ◽

The Impact

Abstract Carbon monoxide poisoning (COP) may cause injuries to the central nervous and endocrine systems, which might increase the risk of developing hypothyroidism. We wanted to evaluate the association between COP and the risk of developing hypothyroidism because epidemiological data on this potential association are limited. We conducted a nationwide population-based cohort study using the Nationwide Poisoning Database and identified 24,328 COP subjects diagnosed between 1999 and 2012. By matching the index date and age, we selected 72,984 non-COP subjects for comparison. Subjects with thyroid diseases and malignancy before 1999 were excluded. We followed up the two groups of subjects until 2013 and compared the risk of developing hypothyroidism. COP subjects had a significantly higher risk for hypothyroidism than non-COP subjects (adjusted hazard ratio [AHR]: 3.8; 95% confidence interval [CI]: 3.2–4.7) after adjusting for age, sex, underlying comorbidities, and monthly income, and the AHR was particular higher in subjects with diabetes mellitus, hyperlipidemia, and mental disorder. The increased risk was highest in the first month after COP (AHR: 41.0; 95% CI: 5.4–310.6), and the impact remained significant even after 4 years. In conclusion, COP was associated with an increased risk for hypothyroidism. Further studies regarding the underlying mechanisms are warranted.

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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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